Robotic surgical tool with replaceable carriage

ABSTRACT

A method of assembling a robotic surgical tool includes providing a handle having first and second ends, a lead screw, and a spline extendable between the first and second ends. The lead screw is rotated in a first direction to translate an elevator layer of a carriage proximally along a longitudinal axis of the handle, the elevator layer being movably mounted to the lead screw at a carriage nut. One or more additional layers of the carriage are removably coupled to the elevator layer and an elongate shaft extends distally from the additional layers, and an end effector is arranged at a distal end of the shaft. The elevator layer is penetrated by the end effector and the shaft upon coupling the additional layers to the elevator layer, and the lead screw is rotated in a second direction opposite the first direction to translate the carriage distally.

TECHNICAL FIELD

The systems and methods disclosed herein are directed to surgical toolsand, more particularly to, a robotic surgical tool having a stageportion and an instrument portion removably secured to the stageportion.

BACKGROUND

Minimally invasive surgical (MIS) instruments are often preferred overtraditional open surgical devices due to the reduced post-operativerecovery time and minimal scarring. The most common MIS procedure may beendoscopy, and the most common form of endoscopy is laparoscopy, inwhich one or more small incisions are formed in the abdomen of a patientand a trocar is inserted through the incision to form a pathway thatprovides access to the abdominal cavity. The cannula and sealing systemof the trocar is used to introduce various instruments and tools intothe abdominal cavity, as well as to provide insufflation to elevate theabdominal wall above the organs. The instruments can be used to engageand/or treat tissue in a number of ways to achieve a diagnostic ortherapeutic effect.

Each surgical tool typically includes an end effector arranged at itsdistal end. Example end effectors include clamps, graspers, scissors,staplers, suction irrigators, blades (i.e., RF), and needle holders, andare similar to those used in conventional (open) surgery except that theend effector of each tool is separated from its handle by anapproximately 12-inch long shaft. A camera or image capture device, suchas an endoscope, is also commonly introduced into the abdominal cavityto enable the surgeon to view the surgical field and the operation ofthe end effectors during operation. The surgeon is able to view theprocedure in real-time by means of a visual display in communicationwith the image capture device.

Various robotic systems have recently been developed to assist in MISprocedures. Robotic systems can allow for more intuitive hand movementsby maintaining natural eye-hand axis. Robotic systems can also allow formore degrees of freedom in movement by including a “wrist” joint thatcreates a more natural hand-like articulation and allows for access tohard to reach spaces. The instrument's end effector can be articulated(moved) using motors and actuators forming part of a computerized motionsystem. A user (e.g., a surgeon) is able to remotely operate aninstrument's end effector by grasping and manipulating in space one ormore controllers that communicate with an instrument driver coupled tothe surgical instrument. User inputs are processed by a computer systemincorporated into the robotic surgical system and the instrument driverresponds by actuating the motors and actuators of the motion system.Moving the drive cables and/or other mechanical mechanisms manipulatesthe end effector to desired positions and configurations.

Improvements to robotically-enabled medical systems will providephysicians with the ability to perform endoscopic and laparoscopicprocedures more effectively and with improved ease.

SUMMARY OF DISCLOSURE

Various details of the present disclosure are hereinafter summarized toprovide a basic understanding. This summary is not an extensive overviewof the disclosure and is neither intended to identify certain elementsof the disclosure, nor to delineate the scope thereof. Rather, theprimary purpose of this summary is to present some concepts of thedisclosure in a simplified form prior to the more detailed descriptionthat is presented hereinafter.

Embodiments disclosed herein include a method of assembling a surgicaltool. The method includes providing a handle having a first end, asecond end, and a lead screw and at least one spline extendable betweenthe first and second ends. The method may further include rotating thelead screw in a first direction and thereby translating an elevatorlayer of a carriage proximally along a longitudinal axis of the handle,wherein the elevator layer is movably mounted to the lead screw at acarriage nut, removably coupling one or more additional layers of thecarriage to the elevator layer, wherein an elongate shaft extendsdistally from the one or more additional layers and an end effector isarranged at a distal end of the elongate shaft, penetrating the elevatorlayer with the end effector and the elongate shaft upon coupling the oneor more additional layers to the elevator layer, and rotating the leadscrew in a second direction opposite the first direction and therebytranslating the carriage distally along the longitudinal axis. In afurther embodiment, the method also includes coupling a cap to thesecond end. In another further embodiment, the step of coupling the capto the second end further includes receiving an end of the at least onespline in at least one spline coupling provided on the cap upon couplingthe cap to the second end, and receiving an end of the lead screw in astage coupling provided on the cap upon coupling the cap to the secondend. In another further embodiment, a drive gear and an activatingmechanism are housed in the carriage and operatively coupled togethersuch that rotation of the drive gear correspondingly actuates theactivating mechanism, and the method further includes inserting the atleast one spline through the drive gear and thereby operatively couplingthe drive gear to the at least one spline such that the drive gear isrotatable with rotation of the at least one spline. In another furtherembodiment, the method also includes rotating the at least one spline byactuating a drive input arranged at the first end and operativelycoupled to the at least one spline to thereby rotate the drive gear, andactuating the activating mechanism as the drive gear rotates. In anotherfurther embodiment, the method also includes mating an instrument driverwith the handle at the first end, the instrument driver being arrangedat an end of a robotic arm, mating a drive output of the instrumentdriver with the drive input as the instrument driver is mated to thehandle, and actuating the drive output to rotate the drive input andthereby actuate the activating mechanism. In another further embodiment,the method also includes mating the instrument driver with the handle atthe first end comprises inserting the shaft and the end effector througha central aperture defined longitudinally through the instrument driver.In another further embodiment, the method also includes advancing atleast a portion of the elevator layer past the second end beforeremovably coupling the one or more additional layers of the carriage tothe elevator layer. In another further embodiment, the method alsoincludes penetrating the first end with the end effector and the shaftas the carriage translates distally. In another further embodiment, themethod also includes removing a cap from the second end to expose afloor of the elevator layer before removably coupling the one or moreadditional layers of the carriage to the elevator layer. In anotherfurther embodiment, one or more snaps extend from the one or moreadditional layers for engaging corresponding opening in the elevatorlayer, and the method further includes inserting the one or more snapsof the one or more additional layers into the corresponding openings inthe elevator layer and thereby securing the one or more additionallayers on the elevator floor. In another further embodiment, the methodalso includes retaining the one or more snaps of the one or moreadditional layers into the corresponding openings in the elevator layeras the carriage distally translates. In another further embodiment, thehandle includes a shroud within which the carriage translates, and themethod further includes advancing the elevator layer such that theelevator floor and the corresponding openings extend outside of theshroud before removably coupling the one or more additional layers ofthe carriage to the elevator layer. In another further embodiment, themethod also includes securing the one or more snaps of the one or moreadditional layers within the corresponding openings in the elevatorlayer as the carriage pulls the one or more snaps and correspondingopenings into the shroud. In another further embodiment, the method alsoincludes detaching the one or more additional layers from the elevatorlayer and thereby removing the one or more additional layers, theelongate shaft, and the end effector from the handle. In another furtherembodiment, the method also includes removably coupling one or moreadditional new layers of the carriage to the elevator layer, wherein anew elongate shaft extends distally from the one or more additional newlayers and a new end effector is arranged at a distal end of the newelongate shaft, and penetrating the elevator layer with the new endeffector and the new elongate shaft upon coupling the one or moreadditional new layers to the elevator layer.

Embodiments disclosed herein may further include a method that includesproviding a handle having a first end, a second end, a lead screw and atleast one spline extendable between the first and second ends, and anelevator layer movably mounted to the lead screw at a carriage nut,inserting the at least one spline through a drive gear housed in atleast one additional layer and thereby operatively coupling the drivegear and the at least one spline such that the drive gear is rotatablewith the at least one spline, and removably coupling the at least oneadditional layer to the elevator layer to define a carriage, wherein anelongate shaft extends distally from the one or more additional layersand an end effector is arranged at a distal end of the elongate shaft,and wherein an activating mechanism is housed in the at least oneadditional layer and operatively coupled to the drive gear such thatrotation of the drive gear correspondingly actuates the activatingmechanism. In a further embodiment, the method includes rotating the atleast one spline by actuating a drive input arranged at the first endand operatively coupled to the at least one spline to thereby rotate thedrive gear, and actuating the activating mechanism as the drive gearrotates.

Embodiments disclosed herein may further include a method that includesremoving an end cap from a stage portion of the surgical tool, where thestage portion includes a handle having a first end and a second end, alead screw and at least one spline extendable between the first andsecond ends, and an elevator layer of a carriage movably mounted to thelead screw and the at least one spline. The method may further includeadvancing the carriage to the second end and detaching a firstinstrument portion from the stage portion, where the first instrumentportion includes one or more first additional layers removably coupledto the elevator layer, and a first elongate shaft extending distallyfrom the one or more first additional layers and having a first endeffector arranged at a distal end of the first shaft. The method mayfurther include replacing the first instrument portion with a secondinstrument portion coupled to the stage portion, where the secondinstrument portion includes one or more second additional layersremovably coupleable to the elevator layer, and a second elongate shaftextending distally from the one or more second additional layers andhaving a second end effector arranged at a distal end of the secondshaft. In a further embodiment, a shroud may extend between the firstand second ends, and advancing the carriage to the second end comprisesadvancing the carriage until the elevator layer at least partiallyprotrudes from the shroud.

BRIEF DESCRIPTION OF THE DRAWINGS

The disclosed aspects will hereinafter be described in conjunction withthe appended drawings, provided to illustrate and not to limit thedisclosed aspects, wherein like designations denote like elements.

FIG. 1 illustrates an embodiment of a cart-based robotic system arrangedfor diagnostic and/or therapeutic bronchoscopy procedure(s).

FIG. 2 depicts further aspects of the robotic system of FIG. 1.

FIG. 3A illustrates an embodiment of the robotic system of FIG. 1arranged for ureteroscopy.

FIG. 3B illustrates an embodiment of the robotic system of FIG. 1arranged for a vascular procedure.

FIG. 4 illustrates an embodiment of a table-based robotic systemarranged for a bronchoscopy procedure.

FIG. 5 provides an alternative view of the robotic system of FIG. 4.

FIG. 6 illustrates an example system configured to stow robotic arm(s).

FIG. 7A illustrates an embodiment of a table-based robotic systemconfigured for a ureteroscopy procedure.

FIG. 7B illustrates an embodiment of a table-based robotic systemconfigured for a laparoscopic procedure.

FIG. 7C illustrates an embodiment of the table-based robotic system ofFIGS. 4-7B with pitch or tilt adjustment.

FIG. 8 provides a detailed illustration of the interface between thetable and the column of the table-based robotic system of FIGS. 4-7.

FIG. 9A illustrates an alternative embodiment of a table-based roboticsystem.

FIG. 9B illustrates an end view of the table-based robotic system ofFIG. 9A.

FIG. 9C illustrates an end view of a table-based robotic system withrobotic arms attached thereto.

FIG. 10 illustrates an exemplary instrument driver.

FIG. 11 illustrates an exemplary medical instrument with a pairedinstrument driver.

FIG. 12 illustrates an alternative design for an instrument driver andinstrument where the axes of the drive units are parallel to the axis ofthe elongated shaft of the instrument.

FIG. 13 illustrates an instrument having an instrument-based insertionarchitecture.

FIG. 14 illustrates an exemplary controller.

FIG. 15 depicts a block diagram illustrating a localization system thatestimates a location of one or more elements of the robotic systems ofFIGS. 1-7C, such as the location of the instrument of FIGS. 11-13, inaccordance to an example embodiment.

FIG. 16 is an isometric side view of an example surgical tool that mayincorporate some or all of the principles of the present disclosure.

FIG. 17 is an isometric view of the surgical tool of FIG. 16 whenunassembled from its shroud assembly, according to one or moreembodiments.

FIG. 18A is an isometric view of the tool of FIGS. 16-17 releasablycoupled to an example instrument driver, according to one or moreembodiments.

FIG. 18B provides separated isometric end views of the instrument driverof FIG. 18A and the surgical tool of FIGS. 16-17.

FIG. 19 illustrates the surgical tool of FIGS. 16-17 having a stageportion and an instrument portion when removed from a stage portion,according to one or more embodiments.

FIG. 20A provides an isometric end view of a portion of the instrumentportion of FIG. 19.

FIG. 20B provides an isometric end view of a portion of the stageportion of FIG. 19.

FIG. 21 illustrates a handle of the instrument portion depicted in FIG.20A when unassembled from an elevator of the stage portion depicted inFIG. 20B and when unassembled from a table alignment tool, according toone or more embodiments.

FIG. 22 illustrates table alignment tool of FIG. 21 being utilized toalign the instrument portion and the stage portion of the surgical toolsuch that the handle of the instrument portion may be releasably securedto the elevator of the stage portion, according to one or moreembodiments.

FIGS. 23A-23I illustrate example methods of operating and assembling asurgical tool, according to one or more embodiments.

FIGS. 24A-24B illustrate respective bottom end, top end, andpartially-exploded views of the removable cap of FIG. 19, according toone or more embodiments.

FIGS. 25A-25B illustrate splines configured to telescope from a handleinterface when in a nested condition and when in an at least partiallyunnested condition, respectively, according to one or more embodimentsof the present disclosure.

FIGS. 26A-26B illustrate splines configured to telescope from anelevator of the carriage when in a nested condition and when in an atleast partially unnested condition, respectively, according to one ormore embodiments of the present disclosure.

FIG. 27 illustrates a telescoping spline configuration, according to oneor more embodiments.

FIGS. 28A-28B illustrate a shroud configured to expand and contract withthe telescoping splines in respective collapsed and expanded positions,according to one or more embodiments.

FIG. 29 is an isometric side view of an example stage for a surgicaltool utilizing a translatable drive puck configured to map spline inputto different output locations, according to one or more embodiments.

FIGS. 30A and 30B illustrate a proximal face and a distal face,respectively, of the translatable drive puck of FIG. 29 whenunassembled.

FIG. 31 illustrates internal drive components and gearing arrangeablewithin the translatable drive puck of FIG. 29, according to one or moreembodiments.

FIG. 32 illustrates a removable handle segment of the surgical tooladapted to be releasably secured on the translatable drive puck,according to one or more embodiments.

FIG. 33 is a close up of the removable handle segment of FIG. 32illustrating exemplary internal drive mechanisms, according to one ormore embodiments.

FIG. 34 illustrates how the removable portion may be aligned with thedrive puck during installation.

FIG. 35 illustrates the surgical tool wherein the removable handlesegment of FIG. 32 has been installed within the stage of FIG. 29.

FIG. 36 illustrates the surgical tool having a stage sub-assembly onwhich a modular handle sub-assembly may be installed, according tovarious embodiments.

FIG. 37 illustrates an exemplary installation of the handle sub-assemblyon the stage sub-assembly shown in FIG. 36.

FIG. 38 illustrates a core assembly of the surgical tool, according tovarious other embodiments.

FIG. 39 illustrates an exemplary stage assembly on which the coreassembly of FIG. 38 may be mounted.

FIG. 40 illustrates the surgical tool incorporating yet anotheralternate handle sub-assembly configured to be dropped on or angled intoa stage sub-assembly, according to various embodiments.

FIG. 41 is a cross-sectional side view of a portion of the handlesub-assembly and the stage sub-assembly shown in FIG. 40.

FIGS. 42A-42D illustrate various means of providing access through whicha handle sub-assembly may be dropped on or angled into a stagesub-assembly, according to various embodiments.

DETAILED DESCRIPTION 1. Overview.

Aspects of the present disclosure may be integrated into arobotically-enabled medical system capable of performing a variety ofmedical procedures, including both minimally invasive (e.g.,laparoscopy) and non-invasive (e.g., endoscopy) procedures. Amongendoscopy procedures, the system may be capable of performingbronchoscopy, ureteroscopy, gastroscopy, etc.

In addition to performing the breadth of procedures, the system mayprovide additional benefits, such as enhanced imaging and guidance toassist the physician. Additionally, the system may provide the physicianwith the ability to perform the procedure from an ergonomic positionwithout the need for awkward arm motions and positions. Still further,the system may provide the physician with the ability to perform theprocedure with improved ease of use such that one or more of theinstruments of the system can be controlled by a single user.

Various embodiments will be described below in conjunction with thedrawings for purposes of illustration. It should be appreciated thatmany other implementations of the disclosed concepts are possible, andvarious advantages can be achieved with the disclosed implementations.Headings are included herein for reference and to aid in locatingvarious sections. These headings are not intended to limit the scope ofthe concepts described with respect thereto. Such concepts may haveapplicability throughout the entire specification.

A. Robotic System—Cart.

The robotically-enabled medical system may be configured in a variety ofways depending on the particular procedure. FIG. 1 illustrates anembodiment of a cart-based robotically-enabled system 100 arranged for adiagnostic and/or therapeutic bronchoscopy procedure. For a bronchoscopyprocedure, the robotic system 100 may include a cart 102 having one ormore robotic arms 104 (three shown) to deliver a medical instrument(alternately referred to as a “surgical tool”), such as a steerableendoscope 106 (e.g., a procedure-specific bronchoscope forbronchoscopy), to a natural orifice access point (i.e., the mouth of thepatient) to deliver diagnostic and/or therapeutic tools. As shown, thecart 102 may be positioned proximate to the patient's upper torso inorder to provide access to the access point. Similarly, the robotic arms104 may be actuated to position the bronchoscope relative to the accesspoint. The arrangement in FIG. 1 may also be utilized when performing agastro-intestinal (GI) procedure with a gastroscope, a specializedendoscope for GI procedures.

Once the cart 102 is properly positioned adjacent the patient, therobotic arms 104 are operated to insert the steerable endoscope 106 intothe patient robotically, manually, or a combination thereof. Thesteerable endoscope 106 may comprise at least two telescoping parts,such as an inner leader portion and an outer sheath portion, where eachportion is coupled to a separate instrument driver of a set ofinstrument drivers 108 (alternately referred to as “tool drivers”). Asillustrated, each instrument driver 108 is coupled to the distal end ofa corresponding one of the robotic arms 104. This linear arrangement ofthe instrument drivers 108, which facilitates coaxially aligning theleader portion with the sheath portion, creates a “virtual rail” 110that may be repositioned in space by manipulating the robotic arms 104into different angles and/or positions. Translation of the instrumentdrivers 108 along the virtual rail 110 telescopes the inner leaderportion relative to the outer sheath portion, thus effectively advancingor retracting the endoscope 106 relative to the patient.

As illustrated, the virtual rail 110 (and other virtual rails describedherein) is depicted in the drawings using dashed lines, thus notconstituting any physical structure of the system 100. The angle of thevirtual rail 110 may be adjusted, translated, and pivoted based onclinical application or physician preference. For example, inbronchoscopy, the angle and position of the virtual rail 110 as shownrepresents a compromise between providing physician access to theendoscope 106 while minimizing friction that results from bending theendoscope 106 into the patient's mouth.

After insertion into the patient's mouth, the endoscope 106 may bedirected down the patient's trachea and lungs using precise commandsfrom the robotic system 100 until reaching a target destination oroperative site. In order to enhance navigation through the patient'slung network and/or reach the desired target, the endoscope 106 may bemanipulated to telescopically extend the inner leader portion from theouter sheath portion to obtain enhanced articulation and greater bendradius. The use of separate instrument drivers 108 also allows theleader portion and sheath portion to be driven independent of eachother.

For example, the endoscope 106 may be directed to deliver a biopsyneedle to a target, such as, for example, a lesion or nodule within thelungs of a patient. The needle may be deployed down a working channelthat runs the length of the endoscope 106 to obtain a tissue sample tobe analyzed by a pathologist. Depending on the pathology results,additional tools may be deployed down the working channel of theendoscope for additional biopsies. After identifying a tissue sample tobe malignant, the endoscope 106 may endoscopically deliver tools toresect the potentially cancerous tissue. In some instances, diagnosticand therapeutic treatments can be delivered in separate procedures. Inthose circumstances, the endoscope 106 may also be used to deliver afiducial marker to “mark” the location of a target nodule as well. Inother instances, diagnostic and therapeutic treatments may be deliveredduring the same procedure.

The system 100 may also include a movable tower 112, which may beconnected via support cables to the cart 102 to provide support forcontrols, electronics, fluidics, optics, sensors, and/or power to thecart 102. Placing such functionality in the tower 112 allows for asmaller form factor cart 102 that may be more easily adjusted and/orre-positioned by an operating physician and his/her staff. Additionally,the division of functionality between the cart/table and the supporttower 112 reduces operating room clutter and facilitates improvingclinical workflow. While the cart 102 may be positioned close to thepatient, the tower 112 may alternatively be stowed in a remote locationto stay out of the way during a procedure.

In support of the robotic systems described above, the tower 112 mayinclude component(s) of a computer-based control system that storescomputer program instructions, for example, within a non-transitorycomputer-readable storage medium such as a persistent magnetic storagedrive, solid state drive, etc. The execution of those instructions,whether the execution occurs in the tower 112 or the cart 102, maycontrol the entire system or sub-system(s) thereof. For example, whenexecuted by a processor of the computer system, the instructions maycause the components of the robotics system to actuate the relevantcarriages and arm mounts, actuate the robotics arms, and control themedical instruments. For example, in response to receiving the controlsignal, motors in the joints of the robotic arms 104 may position thearms into a certain posture or angular orientation.

The tower 112 may also include one or more of a pump, flow meter, valvecontrol, and/or fluid access in order to provide controlled irrigationand aspiration capabilities to the system 100 that may be deployedthrough the endoscope 106. These components may also be controlled usingthe computer system of the tower 112. In some embodiments, irrigationand aspiration capabilities may be delivered directly to the endoscope106 through separate cable(s).

The tower 112 may include a voltage and surge protector designed toprovide filtered and protected electrical power to the cart 102, therebyavoiding placement of a power transformer and other auxiliary powercomponents in the cart 102, resulting in a smaller, more movable cart102.

The tower 112 may also include support equipment for sensors deployedthroughout the robotic system 100. For example, the tower 112 mayinclude opto-electronics equipment for detecting, receiving, andprocessing data received from optical sensors or cameras throughout therobotic system 100. In combination with the control system, suchopto-electronics equipment may be used to generate real-time images fordisplay in any number of consoles deployed throughout the system,including in the tower 112. Similarly, the tower 112 may also include anelectronic subsystem for receiving and processing signals received fromdeployed electromagnetic (EM) sensors. The tower 112 may also be used tohouse and position an EM field generator for detection by EM sensors inor on the medical instrument.

The tower 112 may also include a console 114 in addition to otherconsoles available in the rest of the system, e.g., a console mounted tothe cart 102. The console 114 may include a user interface and a displayscreen (e.g., a touchscreen) for the physician operator. Consoles in thesystem 100 are generally designed to provide both robotic controls aswell as pre-operative and real-time information of the procedure, suchas navigational and localization information of a medical tool. When theconsole 114 is not the only console available to the physician, it maybe used by a second operator, such as a nurse, to monitor the health orvitals of the patient and the operation of system, as well as provideprocedure-specific data, such as navigational and localizationinformation. In other embodiments, the console 114 may be housed in abody separate from the tower 112.

The tower 112 may be coupled to the cart 102 and endoscope 106 throughone or more cables 116 connections. In some embodiments, supportfunctionality from the tower 112 may be provided through a single cable116 extending to the cart 102, thus simplifying and de-cluttering theoperating room. In other embodiments, specific functionality may becoupled in separate cabling and connections. For example, while powermay be provided through a single power cable to the cart 102, supportfor controls, optics, fluidics, and/or navigation may be providedthrough one or more separate cables.

FIG. 2 provides a detailed illustration of an embodiment of the cart 102from the cart-based robotically-enabled system 100 of FIG. 1. The cart102 generally includes an elongated support structure 202 (also referredto as a “column”), a cart base 204, and a console 206 at the top of thecolumn 202. The column 202 may include one or more carriages, such as acarriage 208 (alternatively “arm support”) for supporting the deploymentof the robotic arms 104. The carriage 208 may include individuallyconfigurable arm mounts that rotate along a perpendicular axis to adjustthe base 214 of the robotic arms 104 for better positioning relative tothe patient. The carriage 208 also includes a carriage interface 210that allows the carriage 208 to vertically translate along the column202.

The carriage interface 210 is connected to the column 202 through slots,such as slot 212, that are positioned on opposite sides of the column202 to guide the vertical translation of the carriage 208. The slot 212contains a vertical translation interface to position and hold thecarriage 208 at various vertical heights relative to the cart base 204.Vertical translation of the carriage 208 allows the cart 102 to adjustthe reach of the robotic arms 104 to meet a variety of table heights,patient sizes, and physician preferences. Similarly, the individuallyconfigurable arm mounts on the carriage 208 allow a base 214 of therobotic arms 104 to be angled in a variety of configurations.

In some embodiments, the slot 212 may be supplemented with slot covers(not shown) that are flush and parallel to the slot surface to preventdirt and fluid ingress into the internal chambers of the column 202 andthe vertical translation interface as the carriage 208 verticallytranslates. The slot covers may be deployed through pairs of springspools positioned near the vertical top and bottom of the slot 212. Thecovers are coiled within the spools until deployed to extend and retractfrom their coiled state as the carriage 208 vertically translates up anddown. The spring-loading of the spools provides force to retract thecover into a spool when carriage 208 translates towards the spool, whilealso maintaining a tight seal when the carriage 208 translates away fromthe spool. The covers may be connected to the carriage 208 using, forexample, brackets in the carriage interface 210 to ensure properextension and retraction of the cover as the carriage 208 translates.

The column 202 may internally comprise mechanisms, such as gears andmotors, that are designed to use a vertically aligned lead screw totranslate the carriage 208 in a mechanized fashion in response tocontrol signals generated in response to user inputs, e.g., inputs fromthe console 206.

The robotic arms 104 may generally comprise robotic arm bases 214 andend effectors 216 (three shown), separated by a series of linkages 218connected by a corresponding series of joints 220, each joint 220including an independent actuator, and each actuator including anindependently controllable motor. Each independently controllable joint220 represents an independent degree of freedom available to thecorresponding robotic arm 104. In the illustrated embodiment, each arm104 has seven joints 220, providing seven degrees of freedom. Amultitude of joints 220 result in a multitude of degrees of freedom,allowing for “redundant” degrees of freedom. Redundant degrees offreedom allow the robotic arms 104 to position its respective endeffectors 216 at a specific position, orientation, and trajectory inspace using different linkage positions and joint angles. This allowsfor the system 100 to position and direct a medical instrument from adesired point in space while allowing the physician to move the armjoints 220 into a clinically advantageous position away from the patientto create greater access, while avoiding arm collisions.

The cart base 204 balances the weight of the column 202, carriage 208,and arms 104 over the floor. Accordingly, the cart base 204 housesheavier components, such as electronics, motors, power supply, as wellas components that either enable movement and/or immobilize the cart.For example, the cart base 204 includes rollable casters 222 that allowfor the cart 102 to easily move around a room prior to a procedure.After reaching an appropriate position, the casters 222 may beimmobilized using locks to hold the cart 102 in place during theprocedure.

Positioned at the vertical end of the column 202, the console 206 allowsfor both a user interface for receiving user input and a display screen(or a dual-purpose device such as, for example, a touchscreen 224) toprovide the physician user with both pre-operative and intra-operativedata. Potential pre-operative data on the touchscreen 224 may includepre-operative plans, navigation and mapping data derived frompre-operative computerized tomography (CT) scans, and/or notes frompre-operative patient interviews. Intra-operative data on thetouchscreen 224 may include optical information provided from the tool,sensor and coordinate information from sensors, as well as vital patientstatistics, such as respiration, heart rate, and/or pulse. The console206 may be positioned and tilted to allow a physician to access theconsole from the side of the column 202 opposite carriage 208. From thisposition, the physician may view the console 206, the robotic arms 104,and the patient while operating the console 206 from behind the cart102. As shown, the console 206 also includes a handle 226 to assist withmaneuvering and stabilizing cart 102.

FIG. 3A illustrates an embodiment of the system 100 of FIG. 1 arrangedfor ureteroscopy. In a ureteroscopic procedure, the cart 102 may bepositioned to deliver a ureteroscope 302, a procedure-specific endoscopedesigned to traverse a patient's urethra and ureter, to the lowerabdominal area of the patient. In ureteroscopy, it may be desirable forthe ureteroscope 302 to be directly aligned with the patient's urethrato reduce friction and forces on the sensitive anatomy. As shown, thecart 102 may be aligned at the foot of the table to allow the roboticarms 104 to position the ureteroscope 302 for direct linear access tothe patient's urethra. From the foot of the table, the robotic arms 104may insert the ureteroscope 302 along a virtual rail 304 directly intothe patient's lower abdomen through the urethra.

After insertion into the urethra, using similar control techniques as inbronchoscopy, the ureteroscope 302 may be navigated into the bladder,ureters, and/or kidneys for diagnostic and/or therapeutic applications.For example, the ureteroscope 302 may be directed into the ureter andkidneys to break up kidney stone build-up using a laser or ultrasoniclithotripsy device deployed down a working channel of the ureteroscope302. After lithotripsy is complete, the resulting stone fragments may beremoved using baskets deployed down the working channel of theureteroscope 302.

FIG. 3B illustrates another embodiment of the system 100 of FIG. 1arranged for a vascular procedure. In a vascular procedure, the system100 may be configured such that the cart 102 may deliver a medicalinstrument 306, such as a steerable catheter, to an access point in thefemoral artery in the patient's leg. The femoral artery presents both alarger diameter for navigation as well as a relatively less circuitousand tortuous path to the patient's heart, which simplifies navigation.As in an ureteroscopic procedure, the cart 102 may be positioned towardsthe patient's legs and lower abdomen to allow the robotic arms 104 toprovide a virtual rail 308 with direct linear access to the femoralartery access point in the patient's thigh/hip region. After insertioninto the artery, the medical instrument 306 may be directed and advancedby translating the instrument drivers 108. Alternatively, the cart 102may be positioned around the patient's upper abdomen in order to reachalternative vascular access points, such as, for example, the carotidand brachial arteries near the patient's shoulder and wrist.

B. Robotic System—Table.

Embodiments of the robotically-enabled medical system may alsoincorporate the patient's table. Incorporation of the table reduces theamount of capital equipment within the operating room by removing thecart, which allows greater access to the patient. FIG. 4 illustrates anembodiment of such a robotically-enabled system 400 arranged for abronchoscopy procedure. As illustrated, the system 400 includes asupport structure or column 402 for supporting platform 404 (shown as a“table” or “bed”) over the floor. Much like in the cart-based systems100, end effectors of the robotic arms 406 of the system 400 compriseinstrument drivers 408 (alternately referred to as “tool drivers”) thatare designed to manipulate an elongated medical instrument, such as abronchoscope 410, through or along a virtual rail 412 formed from thelinear alignment of the instrument drivers 408. In practice, a C-arm forproviding fluoroscopic imaging may be positioned over the patient'supper abdominal area by placing the emitter and detector around thetable 404.

FIG. 5 provides an alternative view of the system 400 without thepatient and medical instrument for discussion purposes. As shown, thecolumn 402 may include one or more carriages 502 shown as ring-shaped inthe system 400, from which the one or more robotic arms 406 may bebased. The carriages 502 may translate along a vertical column interface504 that runs the length (height) of the column 402 to provide differentvantage points from which the robotic arms 406 may be positioned toreach the patient. The carriage(s) 502 may rotate around the column 402using a mechanical motor positioned within the column 402 to allow therobotic arms 406 to have access to multiples sides of the table 404,such as, for example, both sides of the patient. In embodiments withmultiple carriages 502, the carriages 502 may be individually positionedon the column 402 and may translate and/or rotate independent of theother carriages 502. While carriages 502 need not surround the column402 or even be circular, the ring-shape as shown facilitates rotation ofthe carriages 502 around the column 402 while maintaining structuralbalance. Rotation and translation of the carriages 502 allows the system400 to align medical instruments, such as endoscopes and laparoscopes,into different access points on the patient.

In other embodiments (discussed in greater detail below with respect toFIG. 9A), the system 400 can include a patient table or bed withadjustable arm supports in the form of bars or rails extending alongsideit. One or more robotic arms 406 (e.g., via a shoulder with an elbowjoint) can be attached to the adjustable arm supports, which can bevertically adjusted. By providing vertical adjustment, the robotic arms406 are advantageously capable of being stowed compactly beneath thepatient table or bed, and subsequently raised during a procedure.

The arms 406 may be mounted on the carriages 502 through a set of armmounts 506 comprising a series of joints that may individually rotateand/or telescopically extend to provide additional configurability tothe robotic arms 406. Additionally, the arm mounts 506 may be positionedon the carriages 502 such that when the carriages 502 are appropriatelyrotated, the arm mounts 506 may be positioned on either the same side ofthe table 404 (as shown in FIG. 5), on opposite sides of table 404 (asshown in FIG. 7B), or on adjacent sides of the table 404 (not shown).

The column 402 structurally provides support for the table 404, and apath for vertical translation of the carriages 502. Internally, thecolumn 402 may be equipped with lead screws for guiding verticaltranslation of the carriages, and motors to mechanize the translation ofsaid carriages based the lead screws. The column 402 may also conveypower and control signals to the carriage 502 and robotic arms 406mounted thereon.

A table base 508 serves a similar function as the cart base 204 of thecart 102 shown in FIG. 2, housing heavier components to balance thetable/bed 404, the column 402, the carriages 502, and the robotic arms406. The table base 508 may also incorporate rigid casters to providestability during procedures. Deployed from the bottom of the table base508, the casters may extend in opposite directions on both sides of thebase 508 and retract when the system 400 needs to be moved.

In some embodiments, the system 400 may also include a tower (not shown)that divides the functionality of system 400 between table and tower toreduce the form factor and bulk of the table 404. As in earlierdisclosed embodiments, the tower may provide a variety of supportfunctionalities to the table 404, such as processing, computing, andcontrol capabilities, power, fluidics, and/or optical and sensorprocessing. The tower may also be movable to be positioned away from thepatient to improve physician access and de-clutter the operating room.Additionally, placing components in the tower allows for more storagespace in the table base 508 for potential stowage of the robotic arms406. The tower may also include a master controller or console thatprovides both a user interface for user input, such as keyboard and/orpendant, as well as a display screen (or touchscreen) for pre-operativeand intra-operative information, such as real-time imaging, navigation,and tracking information. In some embodiments, the tower may alsocontain holders for gas tanks to be used for insufflation.

In some embodiments, a table base may stow and store the robotic armswhen not in use. FIG. 6 illustrates an embodiment of the system 400 thatis configured to stow robotic arms 606 within a table base 406. In thesystem 400, one or more carriages 602 (one shown) may be verticallytranslated into a base 604 to stow one or more robotic arms 606, one ormore arm mounts 608, and the carriages 602 within the base 604. Basecovers 610 may be translated and retracted open to deploy the carriages602, the arm mounts 608, and the arms 606 around the column 612, andclosed to stow and protect them when not in use. The base covers 610 maybe sealed with a membrane 614 along the edges of its opening to preventdirt and fluid ingress when closed.

FIG. 7A illustrates an embodiment of the robotically-enabled table-basedsystem 400 configured for a ureteroscopy procedure. In ureteroscopy, thetable 404 may include a swivel portion 702 for positioning a patientoff-angle from the column 402 and the table base 508. The swivel portion702 may rotate or pivot around a pivot point (e.g., located below thepatient's head) in order to position the bottom portion of the swivelportion 702 away from the column 402. For example, the pivoting of theswivel portion 702 allows a C-arm (not shown) to be positioned over thepatient's lower abdomen without competing for space with the column (notshown) below table 404. By rotating the carriage (not shown) around thecolumn 402, the robotic arms 406 may directly insert a ureteroscope 704along a virtual rail 706 into the patient's groin area to reach theurethra. In ureteroscopy, stirrups 708 may also be fixed to the swivelportion 702 of the table 404 to support the position of the patient'slegs during the procedure and allow clear access to the patient's groinarea.

FIG. 7B illustrates an embodiment of the system 400 configured for alaparoscopic procedure. In a laparoscopic procedure, through smallincision(s) in the patient's abdominal wall, minimally invasiveinstruments may be inserted into the patient's anatomy. In someembodiments, the minimally invasive instruments comprise an elongatedrigid member, such as a shaft, which is used to access anatomy withinthe patient. After inflation of the patient's abdominal cavity, theinstruments may be directed to perform surgical or medical tasks, suchas grasping, cutting, ablating, suturing, etc. In some embodiments, theinstruments can comprise a scope, such as a laparoscope. As shown inFIG. 7B, the carriages 502 of the system 400 may be rotated andvertically adjusted to position pairs of the robotic arms 406 onopposite sides of the table 404, such that an instrument 710 may bepositioned using the arm mounts 506 to be passed through minimalincisions on both sides of the patient to reach his/her abdominalcavity.

To accommodate laparoscopic procedures, the system 400 may also tilt theplatform to a desired angle. FIG. 7C illustrates an embodiment of thesystem 400 with pitch or tilt adjustment. As shown in FIG. 7C, thesystem 400 may accommodate tilt of the table 404 to position one portionof the table 404 at a greater distance from the floor than the other.Additionally, the arm mounts 506 may rotate to match the tilt such thatthe arms 406 maintain the same planar relationship with table 404. Toaccommodate steeper angles, the column 402 may also include telescopingportions 712 that allow vertical extension of the column 402 to keep thetable 404 from touching the floor or colliding with the base 508.

FIG. 8 provides a detailed illustration of the interface between thetable 404 and the column 402. Pitch rotation mechanism 802 may beconfigured to alter the pitch angle of the table 404 relative to thecolumn 402 in multiple degrees of freedom. The pitch rotation mechanism802 may be enabled by the positioning of orthogonal axes A and B at thecolumn-table interface, each axis actuated by a separate motor 804 a and804 b responsive to an electrical pitch angle command. Rotation alongone screw 806 a would enable tilt adjustments in one axis A, whilerotation along another screw 806 b would enable tilt adjustments alongthe other axis B. In some embodiments, a ball joint can be used to alterthe pitch angle of the table 404 relative to the column 402 in multipledegrees of freedom.

For example, pitch adjustments are particularly useful when trying toposition the table in a Trendelenburg position, i.e., position thepatient's lower abdomen at a higher position from the floor than thepatient's lower abdomen, for lower abdominal surgery. The Trendelenburgposition causes the patient's internal organs to slide towards his/herupper abdomen through the force of gravity, clearing out the abdominalcavity for minimally invasive tools to enter and perform lower abdominalsurgical or medical procedures, such as laparoscopic prostatectomy.

FIGS. 9A and 9B illustrate isometric and end views, respectively, of analternative embodiment of a table-based surgical robotics system 900.The surgical robotics system 900 includes one or more adjustable armsupports 902 that can be configured to support one or more robotic arms(see, for example, FIG. 9C) relative to a table 904. In the illustratedembodiment, a single adjustable arm support 902 is shown, though anadditional arm support can be provided on an opposite side of the table904. The adjustable arm support 902 can be configured so that it canmove relative to the table 904 to adjust and/or vary the position of theadjustable arm support 902 and/or any robotic arms mounted theretorelative to the table 904. For example, the adjustable arm support 902may be adjusted in one or more degrees of freedom relative to the table904. The adjustable arm support 902 provides high versatility to thesystem 900, including the ability to easily stow the one or moreadjustable arm supports 902 and any robotics arms attached theretobeneath the table 904. The adjustable arm support 902 can be elevatedfrom the stowed position to a position below an upper surface of thetable 904. In other embodiments, the adjustable arm support 902 can beelevated from the stowed position to a position above an upper surfaceof the table 904.

The adjustable arm support 902 can provide several degrees of freedom,including lift, lateral translation, tilt, etc. In the illustratedembodiment of FIGS. 9A and 9B, the arm support 902 is configured withfour degrees of freedom, which are illustrated with arrows in FIG. 9A. Afirst degree of freedom allows for adjustment of the adjustable armsupport 902 in the z-direction (“Z-lift”). For example, the adjustablearm support 902 can include a carriage 906 configured to move up or downalong or relative to a column 908 supporting the table 904. A seconddegree of freedom can allow the adjustable arm support 902 to tilt. Forexample, the adjustable arm support 902 can include a rotary joint,which can allow the adjustable arm support 902 to be aligned with thebed in a Trendelenburg position. A third degree of freedom can allow theadjustable arm support 902 to “pivot up,” which can be used to adjust adistance between a side of the table 904 and the adjustable arm support902. A fourth degree of freedom can permit translation of the adjustablearm support 902 along a longitudinal length of the table.

The surgical robotics system 900 in FIGS. 9A and 9B can comprise a table904 supported by a column 908 that is mounted to a base 910. The base910 and the column 908 support the table 904 relative to a supportsurface. A floor axis 912 and a support axis 914 are shown in FIG. 9B.

The adjustable arm support 902 can be mounted to the column 908. Inother embodiments, the arm support 902 can be mounted to the table 904or the base 910. The adjustable arm support 902 can include a carriage906, a bar or rail connector 916 and a bar or rail 918. In someembodiments, one or more robotic arms mounted to the rail 918 cantranslate and move relative to one another.

The carriage 906 can be attached to the column 908 by a first joint 920,which allows the carriage 906 to move relative to the column 908 (e.g.,such as up and down a first or vertical axis 922). The first joint 920can provide the first degree of freedom (“Z-lift”) to the adjustable armsupport 902. The adjustable arm support 902 can include a second joint924, which provides the second degree of freedom (tilt) for theadjustable arm support 902. The adjustable arm support 902 can include athird joint 926, which can provide the third degree of freedom (“pivotup”) for the adjustable arm support 902. An additional joint 928 (shownin FIG. 9B) can be provided that mechanically constrains the third joint926 to maintain an orientation of the rail 918 as the rail connector 916is rotated about a third axis 930. The adjustable arm support 902 caninclude a fourth joint 932, which can provide a fourth degree of freedom(translation) for the adjustable arm support 902 along a fourth axis934.

FIG. 9C illustrates an end view of the surgical robotics system 900 withtwo adjustable arm supports 902 a and 902 b mounted on opposite sides ofthe table 904. A first robotic arm 936 a is attached to the first bar orrail 918 a of the first adjustable arm support 902 a. The first roboticarm 936 a includes a base 938 a attached to the first rail 918 a. Thedistal end of the first robotic arm 936 a includes an instrument drivemechanism or input 940 a that can attach to one or more robotic medicalinstruments or tools. Similarly, the second robotic arm 936 b includes abase 938 a attached to the second rail 918 b. The distal end of thesecond robotic arm 936 b includes an instrument drive mechanism or input940 b configured to attach to one or more robotic medical instruments ortools.

In some embodiments, one or more of the robotic arms 936 a,b comprisesan arm with seven or more degrees of freedom. In some embodiments, oneor more of the robotic arms 936 a,b can include eight degrees offreedom, including an insertion axis (1-degree of freedom includinginsertion), a wrist (3-degrees of freedom including wrist pitch, yaw androll), an elbow (1-degree of freedom including elbow pitch), a shoulder(2-degrees of freedom including shoulder pitch and yaw), and base 938a,b (1-degree of freedom including translation). In some embodiments,the insertion degree of freedom can be provided by the robotic arm 936a,b, while in other embodiments, the instrument itself providesinsertion via an instrument-based insertion architecture.

C. Instrument Driver & Interface.

The end effectors of a system's robotic arms comprise (i) an instrumentdriver (alternatively referred to as “tool driver,” “instrument drivemechanism,” “instrument device manipulator,” and “drive input”) thatincorporate electro-mechanical means for actuating the medicalinstrument and, (ii) a removable or detachable medical instrument, whichmay be devoid of any electro-mechanical components, such as motors. Thisdichotomy may be driven by the need to sterilize medical instrumentsused in medical procedures, and the inability to adequately sterilizeexpensive capital equipment due to their intricate mechanical assembliesand sensitive electronics. Accordingly, the medical instruments may bedesigned to be detached, removed, and interchanged from the instrumentdriver (and thus the system) for individual sterilization or disposal bythe physician or the physician's staff. In contrast, the instrumentdrivers need not be changed or sterilized, and may be draped forprotection.

FIG. 10 illustrates an example instrument driver 1000, according to oneor more embodiments. Positioned at the distal end of a robotic arm, theinstrument driver 1000 comprises of one or more drive output 1002arranged with parallel axes to provide controlled torque to a medicalinstrument via corresponding drive shafts 1004. Each drive output 1002comprises an individual drive shaft 1004 for interacting with theinstrument, a gear head 1006 for converting the motor shaft rotation toa desired torque, a motor 1008 for generating the drive torque, and anencoder 1010 to measure the speed of the motor shaft and providefeedback to control circuitry 1012, which can also be used for receivingcontrol signals and actuating the drive output 1002. Each drive output1002 being independent controlled and motorized, the instrument driver1000 may provide multiple (at least two shown in FIG. 10) independentdrive outputs to the medical instrument. In operation, the controlcircuitry 1012 receives a control signal, transmits a motor signal tothe motor 1008, compares the resulting motor speed as measured by theencoder 1010 with the desired speed, and modulates the motor signal togenerate the desired torque.

For procedures that require a sterile environment, the robotic systemmay incorporate a drive interface, such as a sterile adapter connectedto a sterile drape, that sits between the instrument driver and themedical instrument. The chief purpose of the sterile adapter is totransfer angular motion from the drive shafts of the instrument driverto the drive inputs of the instrument while maintaining physicalseparation, and thus sterility, between the drive shafts and driveinputs. Accordingly, an example sterile adapter may comprise of a seriesof rotational inputs and outputs intended to be mated with the driveshafts of the instrument driver and drive inputs on the instrument.Connected to the sterile adapter, the sterile drape, comprised of athin, flexible material such as transparent or translucent plastic, isdesigned to cover the capital equipment, such as the instrument driver,robotic arm, and cart (in a cart-based system) or table (in atable-based system). Use of the drape would allow the capital equipmentto be positioned proximate to the patient while still being located inan area not requiring sterilization (i.e., non-sterile field). On theother side of the sterile drape, the medical instrument may interfacewith the patient in an area requiring sterilization (i.e., sterilefield).

D. Medical Instrument.

FIG. 11 illustrates an example medical instrument 1100 with a pairedinstrument driver 1102. Like other instruments designed for use with arobotic system, the medical instrument 1100 (alternately referred to asa “surgical tool”) comprises an elongated shaft 1104 (or elongate body)and an instrument base 1106. The instrument base 1106, also referred toas an “instrument handle” due to its intended design for manualinteraction by the physician, may generally comprise rotatable driveinputs 1108, e.g., receptacles, pulleys or spools, that are designed tobe mated with drive outputs 1110 that extend through a drive interfaceon the instrument driver 1102 at the distal end of a robotic arm 1112.When physically connected, latched, and/or coupled, the mated driveinputs 1108 of the instrument base 1106 may share axes of rotation withthe drive outputs 1110 in the instrument driver 1102 to allow thetransfer of torque from the drive outputs 1110 to the drive inputs 1108.In some embodiments, the drive outputs 1110 may comprise splines thatare designed to mate with receptacles on the drive inputs 1108.

The elongated shaft 1104 is designed to be delivered through either ananatomical opening or lumen, e.g., as in endoscopy, or a minimallyinvasive incision, e.g., as in laparoscopy. The elongated shaft 1104 maybe either flexible (e.g., having properties similar to an endoscope) orrigid (e.g., having properties similar to a laparoscope) or contain acustomized combination of both flexible and rigid portions. Whendesigned for laparoscopy, the distal end of a rigid elongated shaft 1104may be connected to an end effector of a surgical tool or medicalinstrument extending from a jointed wrist formed from a clevis with atleast one degree of freedom, such as, for example, a grasper orscissors, that may be actuated based on force from the tendons as thedrive inputs 1108 rotate in response to torque received from the driveoutputs 1110 of the instrument driver 1102. When designed for endoscopy,the distal end of the flexible elongated shaft 1104 may include asteerable or controllable bending section that may be articulated andbent based on torque received from the drive outputs 1110 of theinstrument driver 1102.

In some embodiments, torque from the instrument driver 1102 istransmitted down the elongated shaft 1104 using tendons along the shaft1104. These individual tendons, such as pull wires, may be individuallyanchored to individual drive inputs 1108 within the instrument handle1106. From the handle 1106, the tendons are directed down one or morepull lumens along the elongated shaft 1104 and anchored at the distalportion of the elongated shaft 1104, or in the wrist at the distalportion of the elongated shaft. During a surgical procedure, such as alaparoscopic, endoscopic, or a hybrid procedure, these tendons may becoupled to a distally mounted end effector, such as a wrist, a grasper,or scissors. Under such an arrangement, torque exerted on the driveinputs 1108 would transfer tension to the tendon, thereby causing theend effector to actuate in some way. In some embodiments, during asurgical procedure, the tendon may cause a joint to rotate about anaxis, thereby causing the end effector to move in one direction oranother. Alternatively, the tendon may be connected to one or more jawsof a grasper at distal end of the elongated shaft 1104, where tensionfrom the tendon cause the grasper to close.

In endoscopy, the tendons may be coupled to a bending or articulatingsection positioned along the elongated shaft 1104 (e.g., at the distalend) via adhesive, control ring, or other mechanical fixation. Whenfixedly attached to the distal end of a bending section, torque exertedon drive inputs 1108 would be transmitted down the tendons, causing thesofter, bending section (sometimes referred to as the articulablesection or region) to bend or articulate. Along the non-bendingsections, it may be advantageous to spiral or helix the individual pulllumens that direct the individual tendons along (or inside) the walls ofthe endoscope shaft to balance the radial forces that result fromtension in the pull wires. The angle of the spiraling and/or spacingthere between may be altered or engineered for specific purposes,wherein tighter spiraling exhibits lesser shaft compression under loadforces, while lower amounts of spiraling results in greater shaftcompression under load forces, but also exhibits limits bending. On theother end of the spectrum, the pull lumens may be directed parallel tothe longitudinal axis of the elongated shaft 1104 to allow forcontrolled articulation in the desired bending or articulable sections.

In endoscopy, the elongated shaft 1104 houses a number of components toassist with the robotic procedure. The shaft may comprise of a workingchannel for deploying surgical tools (or medical instruments),irrigation, and/or aspiration to the operative region at the distal endof the shaft 1104. The shaft 1104 may also accommodate wires and/oroptical fibers to transfer signals to/from an optical assembly at thedistal tip, which may include of an optical camera. The shaft 1104 mayalso accommodate optical fibers to carry light from proximally-locatedlight sources, such as light emitting diodes, to the distal end of theshaft.

At the distal end of the instrument 1100, the distal tip may alsocomprise the opening of a working channel for delivering tools fordiagnostic and/or therapy, irrigation, and aspiration to an operativesite. The distal tip may also include a port for a camera, such as afiberscope or a digital camera, to capture images of an internalanatomical space. Relatedly, the distal tip may also include ports forlight sources for illuminating the anatomical space when using thecamera.

In the example of FIG. 11, the drive shaft axes, and thus the driveinput axes, are orthogonal to the axis of the elongated shaft. Thisarrangement, however, complicates roll capabilities for the elongatedshaft 1104. Rolling the elongated shaft 1104 along its axis whilekeeping the drive inputs 1108 static results in undesirable tangling ofthe tendons as they extend off the drive inputs 1108 and enter pulllumens within the elongated shaft 1104. The resulting entanglement ofsuch tendons may disrupt any control algorithms intended to predictmovement of the flexible elongated shaft during an endoscopic procedure.

FIG. 12 illustrates an alternative design for a circular instrumentdriver 1200 and corresponding instrument 1202 (alternately referred toas a “surgical tool”) where the axes of the drive units are parallel tothe axis of the elongated shaft 1206 of the instrument 1202. As shown,the instrument driver 1200 comprises four drive units with correspondingdrive outputs 1208 aligned in parallel at the end of a robotic arm 1210.The drive units and their respective drive outputs 1208 are housed in arotational assembly 1212 of the instrument driver 1200 that is driven byone of the drive units within the assembly 1212. In response to torqueprovided by the rotational drive unit, the rotational assembly 1212rotates along a circular bearing that connects the rotational assembly1212 to a non-rotational portion 1214 of the instrument driver 1200.Power and control signals may be communicated from the non-rotationalportion 1214 of the instrument driver 1200 to the rotational assembly1212 through electrical contacts maintained through rotation by abrushed slip ring connection (not shown). In other embodiments, therotational assembly 1212 may be responsive to a separate drive unit thatis integrated into the non-rotatable portion 1214, and thus not inparallel with the other drive units. The rotational assembly 1212 allowsthe instrument driver 1200 to rotate the drive units and theirrespective drive outputs 1208 as a single unit around an instrumentdriver axis 1216.

Like earlier disclosed embodiments, the instrument 1202 may include anelongated shaft 1206 and an instrument base 1218 (shown in phantom)including a plurality of drive inputs 1220 (such as receptacles,pulleys, and spools) that are configured to mate with the drive outputs1208 of the instrument driver 1200. Unlike prior disclosed embodiments,the instrument shaft 1206 extends from the center of the instrument base1218 with an axis substantially parallel to the axes of the drive inputs1220, rather than orthogonal as in the design of FIG. 11.

When coupled to the rotational assembly 1212 of the instrument driver1200, the medical instrument 1202, comprising instrument base 1218 andinstrument shaft 1206, rotates in combination with the rotationalassembly 1212 about the instrument driver axis 1216. Since theinstrument shaft 1206 is positioned at the center of the instrument base1218, the instrument shaft 1206 is coaxial with the instrument driveraxis 1216 when attached. Thus, rotation of the rotational assembly 1212causes the instrument shaft 1206 to rotate about its own longitudinalaxis. Moreover, as the instrument base 1218 rotates with the instrumentshaft 1206, any tendons connected to the drive inputs 1220 in theinstrument base 1218 are not tangled during rotation. Accordingly, theparallelism of the axes of the drive outputs 1208, the drive inputs1220, and the instrument shaft 1206 allows for the shaft rotationwithout tangling any control tendons.

FIG. 13 illustrates a medical instrument 1300 having an instrument basedinsertion architecture in accordance with some embodiments. Theinstrument 1300 (alternately referred to as a “surgical tool”) can becoupled to any of the instrument drivers discussed herein above and, asillustrated, can include an elongated shaft 1302, an end effector 1304connected to the shaft 1302, and a handle 1306 coupled to the shaft1302. The elongated shaft 1302 comprises a tubular member having aproximal portion 1308 a and a distal portion 1308 b. The elongated shaft1302 comprises one or more channels or grooves 1310 along its outersurface and configured to receive one or more wires or cables 1312therethrough. One or more cables 1312 thus run along an outer surface ofthe elongated shaft 1302. In other embodiments, the cables 1312 can alsorun through the elongated shaft 1302. Manipulation of the cables 1312(e.g., via an instrument driver) results in actuation of the endeffector 1304.

The instrument handle 1306, which may also be referred to as aninstrument base, may generally comprise an attachment interface 1314having one or more mechanical inputs 1316, e.g., receptacles, pulleys orspools, that are designed to be reciprocally mated with one or moretorque couplers on an attachment surface of an instrument driver.

In some embodiments, the instrument 1300 comprises a series of pulleysor cables that enable the elongated shaft 1302 to translate relative tothe handle 1306. In other words, the instrument 1300 itself comprises aninstrument-based insertion architecture that accommodates insertion ofthe instrument, thereby minimizing the reliance on a robot arm toprovide insertion of the instrument 1300. In other embodiments, arobotic arm can be largely responsible for instrument insertion.

E. Controller.

Any of the robotic systems described herein can include an input deviceor controller for manipulating an instrument attached to a robotic arm.In some embodiments, the controller can be coupled (e.g.,communicatively, electronically, electrically, wirelessly and/ormechanically) with an instrument such that manipulation of thecontroller causes a corresponding manipulation of the instrument e.g.,via master slave control.

FIG. 14 is a perspective view of an embodiment of a controller 1400. Inthe present embodiment, the controller 1400 comprises a hybridcontroller that can have both impedance and admittance control. In otherembodiments, the controller 1400 can utilize just impedance or passivecontrol. In other embodiments, the controller 1400 can utilize justadmittance control. By being a hybrid controller, the controller 1400advantageously can have a lower perceived inertia while in use.

In the illustrated embodiment, the controller 1400 is configured toallow manipulation of two medical instruments, and includes two handles1402. Each of the handles 1402 is connected to a gimbal 1404, and eachgimbal 1404 is connected to a positioning platform 1406.

As shown in FIG. 14, each positioning platform 1406 includes a selectivecompliance assembly robot arm (SCARA) 1408 coupled to a column 1410 by aprismatic joint 1412. The prismatic joints 1412 are configured totranslate along the column 1410 (e.g., along rails 1414) to allow eachof the handles 1402 to be translated in the z-direction, providing afirst degree of freedom. The SCARA arm 1408 is configured to allowmotion of the handle 1402 in an x-y plane, providing two additionaldegrees of freedom.

In some embodiments, one or more load cells are positioned in thecontroller 1400. For example, in some embodiments, a load cell (notshown) is positioned in the body of each of the gimbals 1404. Byproviding a load cell, portions of the controller 1400 are capable ofoperating under admittance control, thereby advantageously reducing theperceived inertia of the controller 1400 while in use. In someembodiments, the positioning platform 1406 is configured for admittancecontrol, while the gimbal 1404 is configured for impedance control. Inother embodiments, the gimbal 1404 is configured for admittance control,while the positioning platform 1406 is configured for impedance control.Accordingly, for some embodiments, the translational or positionaldegrees of freedom of the positioning platform 1406 can rely onadmittance control, while the rotational degrees of freedom of thegimbal 1404 rely on impedance control.

F. Navigation and Control.

Traditional endoscopy may involve the use of fluoroscopy (e.g., as maybe delivered through a C-arm) and other forms of radiation-based imagingmodalities to provide endoluminal guidance to an operator physician. Incontrast, the robotic systems contemplated by this disclosure canprovide for non-radiation-based navigational and localization means toreduce physician exposure to radiation and reduce the amount ofequipment within the operating room. As used herein, the term“localization” may refer to determining and/or monitoring the positionof objects in a reference coordinate system. Technologies such aspre-operative mapping, computer vision, real-time EM tracking, and robotcommand data may be used individually or in combination to achieve aradiation-free operating environment. In other cases, whereradiation-based imaging modalities are still used, the pre-operativemapping, computer vision, real-time EM tracking, and robot command datamay be used individually or in combination to improve upon theinformation obtained solely through radiation-based imaging modalities.

FIG. 15 is a block diagram illustrating a localization system 1500 thatestimates a location of one or more elements of the robotic system, suchas the location of the instrument, in accordance to an exampleembodiment. The localization system 1500 may be a set of one or morecomputer devices configured to execute one or more instructions. Thecomputer devices may be embodied by a processor (or processors) andcomputer-readable memory in one or more components discussed above. Byway of example and not limitation, the computer devices may be in thetower 112 shown in FIG. 1, the cart 102 shown in FIGS. 1-3B, the bedsshown in FIGS. 4-9, etc.

As shown in FIG. 15, the localization system 1500 may include alocalization module 1502 that processes input data 1504 a, 1504 b, 1504c, and 1504 d to generate location data 1506 for the distal tip of amedical instrument. The location data 1506 may be data or logic thatrepresents a location and/or orientation of the distal end of theinstrument relative to a frame of reference. The frame of reference canbe a frame of reference relative to the anatomy of the patient or to aknown object, such as an EM field generator (see discussion below forthe EM field generator).

The various input data 1504 a-d are now described in greater detail.Pre-operative mapping may be accomplished through the use of thecollection of low dose CT scans. Pre-operative CT scans arereconstructed into three-dimensional images, which are visualized, e.g.as “slices” of a cutaway view of the patient's internal anatomy. Whenanalyzed in the aggregate, image-based models for anatomical cavities,spaces and structures of the patient's anatomy, such as a patient lungnetwork, may be generated. Techniques such as center-line geometry maybe determined and approximated from the CT images to develop athree-dimensional volume of the patient's anatomy, referred to as modeldata 1504 a (also referred to as “preoperative model data” whengenerated using only preoperative CT scans). The use of center-linegeometry is discussed in U.S. patent application Ser. No. 14/523,760,the contents of which are herein incorporated in its entirety. Networktopological models may also be derived from the CT-images, and areparticularly appropriate for bronchoscopy.

In some embodiments, the instrument may be equipped with a camera toprovide vision data 1504 b. The localization module 1502 may process thevision data 1504 b to enable one or more vision-based location tracking.For example, the preoperative model data may be used in conjunction withthe vision data 1504 b to enable computer vision-based tracking of themedical instrument (e.g., an endoscope or an instrument advance througha working channel of the endoscope). For example, using the preoperativemodel data 1504 a, the robotic system may generate a library of expectedendoscopic images from the model based on the expected path of travel ofthe endoscope, each image linked to a location within the model.Intra-operatively, this library may be referenced by the robotic systemin order to compare real-time images captured at the camera (e.g., acamera at a distal end of the endoscope) to those in the image libraryto assist localization.

Other computer vision-based tracking techniques use feature tracking todetermine motion of the camera, and thus the endoscope. Some features ofthe localization module 1502 may identify circular geometries in thepreoperative model data 1504 a that correspond to anatomical lumens andtrack the change of those geometries to determine which anatomical lumenwas selected, as well as the relative rotational and/or translationalmotion of the camera. Use of a topological map may further enhancevision-based algorithms or techniques.

Optical flow, another computer vision-based technique, may analyze thedisplacement and translation of image pixels in a video sequence in thevision data 1504 b to infer camera movement. Examples of optical flowtechniques may include motion detection, object segmentationcalculations, luminance, motion compensated encoding, stereo disparitymeasurement, etc. Through the comparison of multiple frames overmultiple iterations, movement and location of the camera (and thus theendoscope) may be determined.

The localization module 1502 may use real-time EM tracking to generate areal-time location of the endoscope in a global coordinate system thatmay be registered to the patient's anatomy, represented by thepreoperative model. In EM tracking, an EM sensor (or tracker) comprisingof one or more sensor coils embedded in one or more locations andorientations in a medical instrument (e.g., an endoscopic tool) measuresthe variation in the EM field created by one or more static EM fieldgenerators positioned at a known location. The location informationdetected by the EM sensors is stored as EM data 1504 c. The EM fieldgenerator (or transmitter), may be placed close to the patient to createa low intensity magnetic field that the embedded sensor may detect. Themagnetic field induces small currents in the sensor coils of the EMsensor, which may be analyzed to determine the distance and anglebetween the EM sensor and the EM field generator. These distances andorientations may be intra-operatively “registered” to the patientanatomy (e.g., the preoperative model) in order to determine thegeometric transformation that aligns a single location in the coordinatesystem with a position in the pre-operative model of the patient'sanatomy. Once registered, an embedded EM tracker in one or morepositions of the medical instrument (e.g., the distal tip of anendoscope) may provide real-time indications of the progression of themedical instrument through the patient's anatomy.

Robotic command and kinematics data 1504 d may also be used by thelocalization module 1502 to provide localization data 1506 for therobotic system. Device pitch and yaw resulting from articulationcommands may be determined during pre-operative calibration.Intra-operatively, these calibration measurements may be used incombination with known insertion depth information to estimate theposition of the instrument. Alternatively, these calculations may beanalyzed in combination with EM, vision, and/or topological modeling toestimate the position of the medical instrument within the network.

As FIG. 15 shows, a number of other input data can be used by thelocalization module 1502. For example, although not shown in FIG. 15, aninstrument utilizing shape-sensing fiber can provide shape data that thelocalization module 1502 can use to determine the location and shape ofthe instrument.

The localization module 1502 may use the input data 1504 a-d incombination(s). In some cases, such a combination may use aprobabilistic approach where the localization module 1502 assigns aconfidence weight to the location determined from each of the input data1504 a-d. Thus, where the EM data 1504 c may not be reliable (as may bethe case where there is EM interference) the confidence of the locationdetermined by the EM data 1504 c can be decrease and the localizationmodule 1502 may rely more heavily on the vision data 1504 b and/or therobotic command and kinematics data 1504 d.

As discussed above, the robotic systems discussed herein may be designedto incorporate a combination of one or more of the technologies above.The robotic system's computer-based control system, based in the tower,bed and/or cart, may store computer program instructions, for example,within a non-transitory computer-readable storage medium such as apersistent magnetic storage drive, solid state drive, or the like, that,upon execution, cause the system to receive and analyze sensor data anduser commands, generate control signals throughout the system, anddisplay the navigational and localization data, such as the position ofthe instrument within the global coordinate system, anatomical map, etc.

2. Introduction.

Embodiments of the disclosure relate to systems and techniques forassembling a surgical tool by removably coupling a portion of thesurgical tool to a stage portion of the surgical tool and replacing theportion of the surgical tool with another portion of the surgical toolthat is removably coupleable to the stage portion. The method includesproviding a handle having a first end, a second end, and a lead screwand at least one spline extendable between the first and second ends.The method may further include rotating the lead screw in a firstdirection and thereby translating an elevator layer of a carriageproximally along a longitudinal axis of the handle, wherein the elevatorlayer is movably mounted to the lead screw at a carriage nut, removablycoupling one or more additional layers of the carriage to the elevatorlayer, wherein an elongate shaft extends distally from the one or moreadditional layers and an end effector is arranged at a distal end of theelongate shaft, penetrating the elevator layer with the end effector andthe elongate shaft upon coupling the one or more additional layers tothe elevator layer, and rotating the lead screw in a second directionopposite the first direction and thereby translating the carriagedistally along the longitudinal axis.

Embodiments of the present disclosure may also relate to alternatemethods of assembling a surgical tool. The alternate method includesremoving an end cap from a stage portion of the surgical tool, where thestage portion includes a handle having a first end and a second end, alead screw and at least one spline extendable between the first andsecond ends, and an elevator layer of a carriage movably mounted to thelead screw and the at least one spline. The method may also includeadvancing the carriage to the second end and detaching a firstinstrument portion from the stage portion, where the first instrumentportion includes one or more first additional layers removably coupledto the elevator layer, and a first elongate shaft extending distallyfrom the one or more first additional layers and having a first endeffector arranged at a distal end of the first shaft. The method mayalso include replacing the first instrument portion with a secondinstrument portion coupled to the stage portion, where the secondinstrument portion includes one or more second additional layersremovably coupleable to the elevator layer, and a second elongate shaftextending distally from the one or more second additional layers andhaving a second end effector arranged at a distal end of the secondshaft.

3. Description.

FIG. 16 is an isometric side view of an example surgical tool 1600 thatmay incorporate some or all of the principles of the present disclosure.The surgical tool 1600 may be similar in some respects to any of themedical instruments described above with reference to FIGS. 11-13 and,therefore, may be used in conjunction with a robotic surgical system,such as the robotically-enabled systems 100, 400, and 900 of FIGS. 1-13.As illustrated, the surgical tool 1600 includes an elongated shaft 1602,an end effector 1604 arranged at the distal end of the shaft 1602, andan articulable wrist 1606 (alternately referred to as a “wrist joint”)that couples the end effector 1604 to the distal end of the shaft 1602.

The terms “proximal” and “distal” are defined herein relative to arobotic surgical system having an interface configured to mechanicallyand electrically couple the surgical tool 1600 to a robotic manipulator.The term “proximal” refers to the position of an element closer to therobotic manipulator and the term “distal” refers to the position of anelement closer to the end effector 1604 and thus closer to the patientduring operation. Moreover, the use of directional terms such as above,below, upper, lower, upward, downward, left, right, and the like areused in relation to the illustrative embodiments as they are depicted inthe figures, the upward or upper direction being toward the top of thecorresponding figure and the downward or lower direction being towardthe bottom of the corresponding figure.

The surgical tool 1600 can have any of a variety of configurationscapable of performing one or more surgical functions. In the illustratedembodiment, the end effector 1604 comprises a surgical stapler,alternately referred to as an “endocutter,” configured to cut and staple(fasten) tissue. As illustrated, the end effector 1604 includes opposingjaws 1610, 1612 configured to move (articulate) between open and closedpositions. Alternatively, the end effector 1604 may comprise other typesof instruments having the opposing jaws 1610, 1612 such as, but notlimited to, tissue graspers, surgical scissors, advanced energy vesselsealers, clip appliers, needle drivers, a babcock including a pair ofopposed grasping jaws, bipolar jaws (e.g., bipolar Maryland grasper,forceps, a fenestrated grasper, etc.), etc. In other embodiments, theend effector 1604 may instead comprise any end effector or instrumentcapable of being operated in conjunction with the presently disclosedrobotic surgical systems and methods. Such end effectors or instrumentsinclude, but are not limited to, a suction irrigator, an endoscope(e.g., a camera), or any combination thereof.

One or both of the jaws 1610, 1612 may be configured to pivot to actuatethe end effector 1604 between open and closed positions. In theillustrated example, the second jaw 1612 is rotatable (pivotable)relative to the first jaw 1610 to move between an open, unclampedposition and a closed, clamped position. In other embodiments, however,the first jaw 1610 may move (rotate) relative to the second jaw 1612,without departing from the scope of the disclosure. In yet otherembodiments, both jaws 1610, 1612 may move to actuate the end effector1604 between open and closed positions.

In the illustrated example, the first jaw 1610 may be characterized orotherwise referred to as a “cartridge” or “channel” jaw, and the secondjaw 1612 may be characterized or otherwise referred to as an “anvil”jaw. The first jaw 1610 may include a frame that houses or supports astaple cartridge, and the second jaw 1612 is pivotally supportedrelative to the first jaw 1610 and defines a surface that operates as ananvil to deform staples ejected from the staple cartridge duringoperation.

The wrist 1606 enables the end effector 1604 to articulate (pivot)relative to the shaft 1602 and thereby position the end effector 1604 atvarious desired orientations and locations relative to a surgical site.In the illustrated embodiment, the wrist 1606 is designed to allow theend effector 1604 to pivot (swivel) left and right relative to alongitudinal axis A₁ of the shaft 1602. In other embodiments, however,the wrist 1606 may be designed to provide multiple degrees of freedom,including one or more translational variables (i.e., surge, heave, andsway) and/or one or more rotational variables (i.e., Euler angles orroll, pitch, and yaw). The translational and rotational variablesdescribe the position and orientation of a component of a surgicalsystem (e.g., the end effector 1604) with respect to a given referenceCartesian frame. “Surge” refers to forward and backward translationalmovement, “heave” refers to translational movement up and down, and“sway” refers to translational movement left and right. With regard tothe rotational terms, “roll” refers to tilting side to side, “pitch”refers to tilting forward and backward, and “yaw” refers to turning leftand right.

In the illustrated embodiment, the pivoting motion at the wrist 1606 islimited to movement in a single plane, e.g., only yaw movement relativeto the longitudinal axis A₁. The end effector 1604 is depicted in FIG.16 in the unarticulated position where a longitudinal axis of the endeffector 1604 is substantially aligned with the longitudinal axis A₁ ofthe shaft 1602, such that the end effector 1604 is at a substantiallyzero angle relative to the shaft 1602. In the articulated position, thelongitudinal axis of the end effector 1604 would be angularly offsetfrom the longitudinal axis A₁ such that the end effector 1604 would beoriented at a non-zero angle relative to the shaft 1602.

Still referring to FIG. 16, the surgical tool 1600 may include a drivehousing or “handle” 1614 that operates as an actuation system designedto facilitate articulation of the wrist 1606 and actuation (operation)of the end effector 1604 (e.g., clamping, firing, rotation,articulation, energy delivery, etc.). As described in more detail below,the handle 1614 includes coupling features that releasably couple thesurgical tool 1600 to an instrument driver of a robotic surgical system.

The handle 1614 includes a plurality of drive members (obscured in FIG.16) that extend to the wrist 1606 and the end effector 1604. Selectiveactuation of some drive members causes the end effector 1604 toarticulate (pivot) relative to the shaft 1602 at the wrist 1606.Selective actuation of other drive members cause the end effector 1604to actuate (operate). Actuating the end effector 1604 may includeclosing and/or opening the second jaw 1612 relative to the first jaw1610 (or vice versa), thereby enabling the end effector 1604 to grasp(clamp) onto tissue. Once tissue is grasped or clamped between theopposing jaws 1610, 1612, actuating the end effector 1604 may furtherinclude “firing” the end effector 1604, which may refer to causing acutting element or knife (not visible) to advance distally within a slot(obscured from view) defined in the first jaw 1610. As it movesdistally, the cutting element transects any tissue grasped between theopposing jaws 1610, 1612. Moreover, as the cutting element advancesdistally, a plurality of staples contained within the staple cartridge(e.g., housed within the first jaw 1610) are urged (cammed) intodeforming contact with corresponding anvil surfaces (e.g., pockets)provided on the second jaw 1612. The deployed staples may form multiplerows of staples that seal opposing sides of the transected tissue.

As illustrated, the handle 1614 has a first or “distal” end 1618 a and asecond or “proximal” end 1618 b opposite the first end 1618 a. In someembodiments, one or more struts 1620 (two shown) extend longitudinallybetween the first and second ends 1618 a,b to help fix the distancebetween the first and second ends 1618 a,b, provide structural stabilityto the handle 1614, and secure the first end 1618 a to the second end1618 b. In other embodiments, however, the struts 1620 may be omitted,without departing from the scope of the disclosure.

A lead screw 1622 and one or more splines 1624 also extendlongitudinally between the first and second ends 1618 a,b. In theillustrated embodiment, the handle 1614 includes a first spline 1624 a,a second spline 1624 b, and a third spline 1624 c. While three splines1624 a-c are depicted, more or less than three may be included in thehandle 1614, without departing from the scope of the disclosure. Unlikethe struts 1620, the lead screw 1622 and the splines 1624 a-c arerotatably mounted to the first and second ends 1618 a,b. As described inmore detail below, selective rotation of the lead screw 1622 and thesplines 1624 a-c causes actuation of various components within thehandle 1614, which thereby causes various functions of the surgical tool1600 to transpire, for example, such as translating the end effector1604 along the longitudinal axis A₁, causing the end effector 1604 toarticulate (pivot) at the wrist 1606, and causing the end effector 1604to actuate (operate).

The handle 1614 further includes a carriage or kart 1626 movably mountedalong the lead screw 1622 and the splines 1624 a-c and housing variousactivating mechanisms configured to cause operation of specificfunctions of the end effector 1604. The carriage 1626 may comprise twoor more layers, shown in FIG. 16 as a first layer 1628 a, a second layer1628 b, a third layer 1628 c, a fourth layer 1628 d, and a fifth layer1628 e. While five layers 1628 a-e are depicted, more or less than fivemay be included in the carriage 1626, without departing from the scopeof the disclosure.

In addition, one or more of the layers 1628 a-e of the carriage 1626 maybe detachable relative to the remaining layers 1628 a-e. In this manner,one or more of the layers 1628 a-e of the carriage 1626 may be securedtogether as a block of layers that may be releasably secured to theremaining layer(s) to define the carriage 1628. For example, some of thelayers 1628 a-e may be integrally secured together in series, to form ablock of layers, and such block of layers may be selectively secured tothe remaining one or more layers 1628 a-e that are not integrallysecured to the block of layers. In the illustrated embodiment, thelayers 1628 b-e are secured to each other in series using one or moremechanical fasteners 1630 (one visible) extending between the secondlayer 1628 b and the fifth layer 1628 e and through coaxially alignedholes in each layer 1628 b-e to form a block of layers configured to bereleasably secured to the first layer 1628 a, as described below. In theillustrated example, one or more snaps 1632 (two visible) are utilizedto align (or clock) and releasably attach the block of layers 1628 b-eto the first layer 1628 a, as further described below, but various othertypes of one or more releasable connector(s) may be utilized.

While four layers 1628 b-e are depicted as being secured together viathe mechanical fastener(s) 1630 to define the block of secured-togetherlayers 1628 b-e releasably attached to the first layer 1628 a via thesnaps 1632, the block of secured-together layers may include more orless than four layers, without departing from the scope of thedisclosure. Moreover, one or more additional layers may be mechanicallyfastened in series to the first layer 1628 a (e.g., the second layer1628 b) to define a second block of secured-together layers that isreleasably attached to the first block of secured-together layers (e.g.,the three layers 1628 c-e), without departing from the scope of thedisclosure. As further described below, configuring the carriage 1626with one or more layers that are releasably secured relative to theremaining layers will provide a degree of modularity to the surgicaltool 1600 to thereby allow one or more components of the surgical tool1600 to be interchangeable, reusable, and/or replaceable.

The shaft 1602 is coupled to and extends distally from the carriage 1626through the first end 1618 a of the handle 1614. In the illustratedembodiment, for example, the shaft 1602 penetrates the first end 1618 aat a central aperture defined through the first end 1618 a. The carriage1626 is movable between the first and second ends 1618 a,b along thelongitudinal axis A₁ and is thereby able to advance or retract the endeffector 1604 relative to the handle 1614, as indicated by the arrows B.More specifically, in some embodiments, the carriage 1626 includes acarriage nut 1634 mounted to the lead screw 1622 and secured withrespect to the first layer 1628 a. In this manner, the first layer 1628a of the carriage 1626 may define an elevator upon which the otherlayers 1628 b-e releasably attached thereon may be translated, asdescribed below. The outer surface of the lead screw 1622 defineshelical threading and the carriage nut 1634 defines correspondinginternal helical threading (not shown) matable with the outer helicalthreading of the lead screw 1622. As a result, rotation of the leadscrew 1622 causes the carriage nut 1634 to advance or retract thecarriage 1626 along the longitudinal axis A₁ and correspondingly advanceor retract the end effector 1604 relative to the handle 1614.

As indicated above, the lead screw 1622 and the splines 1624 a-c arerotatably mounted to the first and second ends 1618 a,b. Morespecifically, the first end 1618 a of the handle 1614 may include one ormore rotatable drive inputs, shown as a first drive input 1636 a, asecond drive input 1636 b, a third drive input 1636 c, and a fourthdrive input 1636 d. As discussed in more detail below, each drive input1636 a-d may be matable with a corresponding drive output of aninstrument driver such that movement (rotation) of a given drive outputcorrespondingly moves (rotates) the associated drive input 1636 a-d.

The first drive input 1636 a may be operatively coupled to the leadscrew 1622 such that rotation of the first drive input 1636 acorrespondingly rotates the lead screw 1622, which causes the carriagenut 1634 and the first layer 1628 a constraining the carriage nut 1634to advance or retract along the longitudinal axis A₁, depending on therotational direction of the lead screw 1622. Moreover, as describedherein the first layer 1628 a of the carriage 1626 may be configured asan elevator (of the carriage 1626) that translates the remaining layers1628 b-e of the carriage 1626 releasably connected to the first layer1628 a. Thus, when the remaining layers 1628 b-e are installed on thefirst layer 1628 a, to thereby define the carriage 1626 as depicted inFIG. 16, rotation of the first drive input 1636 a correspondinglyrotates the lead screw 1622, which causes the entirety of the carriage1626 now fully coupled to the carriage nut 1634, to advance or retractalong the longitudinal axis A₁, depending on the rotational direction ofthe lead screw 1622.

The second drive input 1636 b may be operatively coupled to the firstspline 1624 a such that rotation of the second drive input 1636 bcorrespondingly rotates the first spline 1624 a. In some embodiments,the first spline 1624 a may be operatively coupled to a first activatingmechanism 1638 a of the carriage 1626, and the first activatingmechanism 1638 a may be operable to open and close the jaws 1610, 1612.Accordingly, rotating the second drive input 1636 b will correspondinglyactuate the first activating mechanism 1638 a and open or close the jaws1610, 1612, depending on the rotational direction of the first spline1624 a. In addition, the second layer 1628 b is configured toaccommodate the first activating mechanism 1638 a such that the jaws1610, 1612 are operable as described herein and, in the illustratedexample, the first activating mechanism 1638 a is at least partiallyconstrained by the second layer 1628 b and the third layer 1628 c.

The third drive input 1636 c may be operatively coupled to the secondspline 1624 b such that rotation of the third drive input 1636 ccorrespondingly rotates the second spline 1624 b. In some embodiments,the second spline 1624 b may be operatively coupled to a secondactivating mechanism 1638 b of the carriage 1626, and the secondactivating mechanism 1638 b may be operable to articulate the endeffector 1604 at the wrist 1606. Accordingly, rotating the third driveinput 1636 c will correspondingly actuate the second activatingmechanism 1638 b and cause the wrist 1606 to articulate in at least onedegree of freedom, depending on the rotational direction of the secondspline 1624 b. In addition, the third layer 1628 c is configured toaccommodate the second activating mechanism 1638 b for articulation ofthe wrist 1606 as described herein and, in the illustrated example, thesecond activating mechanism 1638 b is at least partially constrained bythe third layer 1628 c and the fourth layer 1628 d.

The fourth drive input 1636 d may be operatively coupled to the thirdspline 1624 c such that rotation of the fourth drive input 1636 dcorrespondingly rotates the third spline 1624 c. In some embodiments,the third spline 1624 c may be operatively coupled to a third activatingmechanism 1638 c of the carriage 1626, and the third activatingmechanism 1638 c may be operable to fire the cutting element (knife) atthe end effector 1604. Accordingly, rotating the fourth drive input 1636d will correspondingly actuate the third activating mechanism 1638 c andcause the knife to advance or retract, depending on the rotationaldirection of the third spline 1624 c. In addition, the fifth layer 1628e is configured to accommodate the third activating mechanism 1638 c forfiring the cutting element of the end effector 1604 as described hereinand, in the illustrated example, the third activating mechanism 1638 cis at least partially constrained by the fifth layer 1628 e and a thrustbearing layer 1628 f of the carriage 1626.

In the illustrated embodiment, the activating mechanisms 1638 a-ccomprise intermeshed gearing assemblies including one or more drivegears driven by rotation of the corresponding spline 1624 a-c andconfigured to drive one or more corresponding driven gears that causeoperation of specific functions of the end effector 1604.

FIG. 16 illustrates an embodiment of the handle 1614 having a shroud1640 that defines a periphery of the handle 1614 for handling andmanipulation by the operator or user. In the illustrated embodiment, theshroud 1640 is depicted as a transparent material (or at least apartially transparent material), such that the internal components ofthe handle 1614 are visible through the shroud 1640. However, in otherexamples, the shroud 1640 need not be transparent. Where included, theshroud 1640 may be sized to receive the lead screw 1622, the splines1624 a-c, and the carriage 1626, as well as other internal components ofthe handle 1614.

In some embodiments, the shroud 1640 may be incorporated in a shroudassembly of the handle 1614. FIG. 17 is an isometric view of thesurgical tool 1600 of FIG. 16 illustrating the handle 1614 whenpartially disassembled, according to one or more embodiments. Inparticular, FIG. 17 depicts an exemplary shroud assembly 1700 of thehandle 1614 incorporating the shroud 1640 when disassembled from theremaining portion of the handle 1614, according to one or moreembodiments. In the illustrated embodiment, the shroud assembly 1700defines a tubular or cylindrical structure having (i) a first end 1702 amatable with the first end 1618 a of the handle 1614 and (ii) a secondend 1702 b opposite the first end 1702 a and matable with the second end1618 b of the handle 1614. The carriage 1626, the lead screw 1622, andthe splines 1624 a-c may all be accommodated within the interior of theshroud 1640, and the carriage 1626 may engage and ride on one or morerails 1704 (sometimes referred to as guide rails) coupled to the shroud1640. The rails 1704 extend longitudinally and parallel to the leadscrew 1622, and the rails 1704 are sized to be received withincorresponding notches 1706 defined on the outer periphery of thecarriage 1626 and, more particularly, on one or more of the layers 1628a-e. As the carriage 1626 translates along the longitudinal axis At, therails 1704 help maintain the angular position of the carriage 1626 andassume any torsional loading that would otherwise adversely affect thecarriage 1626. In addition, the shroud 1640 may include one or morealignment notches 1708 for aligning the second end 1618 b on the shroudassembly 1700. The rails 1704 may be fastened within an interior of theshroud 1640 and, in the illustrated examples, are coupled within theinterior of the shroud 1640 via exterior rails 1710 positioned exteriorthe shroud 1640 and connected to the (guide) rails 1704 via a pluralityof fasteners 1712 that extend through the shroud 1640.

FIG. 18A is an isometric view of the surgical tool 1600 of FIGS. 16 and17 releasably coupled to an example instrument driver 1800, according toone or more embodiments. The instrument driver 1800 may be similar insome respects to the instrument drivers 1102, 1200 of FIGS. 11 and 12,respectively, and therefore may be best understood with referencethereto. Similar to the instrument drivers 1102, 1200, for example, theinstrument driver 1800 may be mounted to or otherwise positioned at theend of a robotic arm (not shown) and designed to provide the motiveforces required to operate the surgical tool 1600. Unlike the instrumentdrivers 1102, 1200, however, the shaft 1602 of the surgical tool 1600extends through and penetrates the instrument driver 1800.

The instrument driver 1800 has a body 1802 having a first or “proximal”end 1804 a and a second or “distal” end 1804 b opposite the first end1804 a. In the illustrated embodiment, the first end 1804 a of theinstrument driver 1800 is matable with the first end 1618 a of thehandle 1614, and the shaft 1602 of the surgical tool 1602 extends intothe first end 1804 a, through the body 1802, and distally from thesecond end 1804 b of the body 1802.

FIG. 18B provides separated isometric end views of the first end 1804 aof the instrument driver 1800 and the first end 1618 a of the handle1614 of the surgical tool 1600 of FIGS. 16 and 17. With the jaws 1610,1612 closed, the shaft 1602 and the end effector 1604 are designed topenetrate the instrument driver 1800 by extending through a centralaperture 1806 defined longitudinally through the body 1802 between thefirst and second ends 1804 a,b. To angularly align the surgical tool1600 with the instrument driver 1800 in a proper angular orientation,one or more alignment guides 1808 may be provided or otherwise definedwithin the central aperture 1806 and configured to engage one or morecorresponding alignment features 1810 provided by the surgical tool 1600(obscured from view, see FIG. 17). In the illustrated embodiment, thealignment feature 1810 comprises a protrusion or projection defined onor otherwise provided by an alignment nozzle 1812 extending distallyfrom the first end 1618 a of the handle 1614. In one or moreembodiments, the alignment guide 1808 may comprise a curved or arcuateshoulder configured to receive the alignment feature 1810 as the shaft1602 enters the central aperture 1806 and guide the surgical tool 1600to a proper angular alignment with the instrument driver 1800 as theshaft 1602 is advanced distally through the central aperture 1806.

In addition, one or more additional alignment features 1814 may bearranged within the central aperture 1806 and configured to mate withone or more corresponding recesses (not illustrated) provided on thealignment nozzle 1812 for ensuring the surgical tool 1600 is installedat a proper rotational alignment with respect to the instrument driver1800.

As illustrated, a drive interface 1816 is provided at the first end 1804a of the instrument driver 1800, and a driven interface 1818 is providedat the first end 1618 a of the handle 1614. The driver and driveninterfaces 1816, 1818 may be configured to mechanically, magnetically,and/or electrically couple the handle 1614 to the instrument driver1800. To accomplish this, the driver and driven interfaces 1816, 1818may provide one or more matable locating features configured to securethe handle 1614 to the instrument driver 1800. In the illustratedembodiment, for example, the drive interface 1816 provides one or moreinterlocking features 1820 (three shown) configured to locate and matewith one or more substantially complimentary shaped pockets 1822 (threeshown) provided on the driven interface 1818. The interlocking features1820, exemplified as bulbous protrusions, may be configured to align andmate with the pockets 1822 via an interference or snap fit engagement,for example.

The instrument driver 1800 also includes one or more drive outputs thatextend through the drive interface 1816 to mate with the drive inputs1636 a-d provided on the driven face 1818 at the first end 1618 a of thehandle 1614. More specifically, in the illustrated embodiment, the driveinterface 1816 of the instrument driver 1800 includes a first driveoutput 1824 a matable with the first drive input 1636 a, a second driveoutput 1824 b matable with the second drive input 1636 b, a third driveoutput 1824 c matable with the third drive input 1636 c, and a fourthdrive output 1824 d matable with the fourth drive input 1636 d. In someembodiments, as illustrated, the drive outputs 1824 a-d may comprisesplines designed to mate with corresponding splined receptacles on thedrive inputs 1636 a-d. Once properly mated, the drive inputs 1636 a-dwill share axes of rotation with the corresponding drive outputs 1824a-d to allow the transfer of rotational torque from the drive outputs1824 a-d to the corresponding drive inputs 1636 a-d. In someembodiments, each drive output 1824 a-d may be spring loaded andotherwise biased to spring outwards away from the drive interface 1816.Each drive output 1824 a-d may be capable of partially or fullyretracting into the drive interface 1816.

In some embodiments, the instrument driver 1800 may include additionaldrive outputs, depicted in FIG. 18B as a fifth drive output 1824 e and asixth drive output 1824 f. The fifth and sixth drive outputs 1824 e,fmay be configured and positioned to mate with additional drive inputs(not shown) of the handle 1614 to help undertake one or more additionalfunctions of the surgical tool. In the illustrated embodiment, thehandle 1614 does not include additional drive inputs, and the driveninterface 1818 defines corresponding pockets 1826 configured to receivethe fifth and sixth drive outputs 1824 e,f.

Removable Carriage Layers on Translating System

The surgical tool 1600 may be modular such that certain features of thesurgical tool 1600 may be removed and replaced. In this manner, aportion of the surgical tool 1600 may be reusable for multiple surgicalprocedures, and thereby reduce capital expenditure. For example, theshaft 1602, the articulable wrist 1606, and the end effector 1604 may bereleasably coupled within the handle 1614 to be operable during amedical procedure and then removed from the handle 1614 following theprocedure and replaced. In these embodiments, the layers of the carriage1626 associated with various functions of the shaft 1602, thearticulable wrist 1606, and the end effector 1604, together with theirassociated activating mechanisms, may be assembled as one or moreseparate components that may be removably secured within the handle1614.

In some embodiments, the layers 1628 b-e are secured to the shaft 1602and the activating mechanisms 1638 a-c are operatively housed withintheir associated layer 1628 b-e so as to actuate the surgical tool 1600as described herein. In the illustrated embodiment, the layers 1628 b-eare fastened together with the mechanical fastener(s) 1630 to constrainthe associated activating mechanisms 1638 a-c in positions where theyintermesh to provide functionality at the end effector 1604 and thewrist 1606. Here, the shaft 1602, the end effector 1604, the articulablewrist 1606, the layers 1628 b-e, and the activating mechanisms 1638 a-care all secured together to define a disposable instrument portion ofthe surgical tool 1600.

In these embodiments, the layers associated with performing otherfunctionality of the surgical tool 1600 may be permanently securedwithin (or to) the handle 1614, thereby defining a reusable portion ofthe surgical tool 1600 that can be employed in more than one surgicalprocedure, and into which the disposable instrument portion may bereleasably installed. In the illustrated embodiment, the first layer1628 a and its associated drive mechanisms define this reusable portionand, because these components are configured to translate the shaft 1602along the longitudinal axis A₁, they also define a stage portion of thesurgical tool 1600 into which the disposable instrument portion may bereleasably installed. Here, the first layer 1628 a of the carriage 1626,the lead screw 1622, and the carriage nut 1634 are operatively securedwithin (or to) the handle 1614, such that the first layer 1628 a definesa type of “elevator” that is translationally driven and onto which thedisposable instrument portion of the surgical tool 1600 may bereleasably secured. Also, one or more of the splines 1624 a-c may beoperably secured within the handle 1614 to form part of the reusablestage portion. In some embodiments, the splines 1624 a-c extend betweenthe first and second ends 1618 a,b, whereas in other embodiments, thesplines 1624 may be configured as expandable or telescoping membersextending between the first end 1618 a and the first layer 1628 a. Insuch embodiments, forces exhibited by the splines 1624 a-c duringrotation may be transferred through the first layer 1628 a to theassociated activating mechanisms 1638 a-c in the disposable instrumentportion to operate the surgical tool 1600.

FIG. 19 illustrates the surgical tool 1600 configured with a stageportion 1902 and an instrument portion 1904 that may releasably attachto the stage portion 1902, according to one or more embodiments. In thisembodiment, the stage portion 1902 may be reused and the instrumentportion 1904 may be removable and disposed of after a predeterminednumber of uses and then replaced with a new (or refurbished) instrumentportion 1904. In the illustrated embodiment, the instrument portion 1904includes various component parts of a surgical stapler (e.g., an“endocutter”), but in other embodiments the stage portion 1902 may beconfigured to receive instrument portions relating to other types ofsurgical tools.

As illustrated, the stage portion 1902 may include a removable cap 1906that may be removed from the shroud 1640 so that the instrument portion1904 may be installed on or otherwise coupled to the stage portion 1902.In some embodiments, the removable cap 1906 is removably attachable tothe second end 1618 b of the handle 1614 and removable to allow theinstrument portion 1904 to be mated with a proximal side of the stage.Here, the instrument portion 1904 includes a handle assembly 1908(alternatively referred to as a “handle drive assembly”) comprising thelayers 1628 b-e, the thrust bearing layer 1628 f, and the associatedactivating mechanisms 1638 a-c constrained thereby, and the shaft 1602operably extends through a correspondingly sized central aperture in atleast a portion of the handle assembly 1908. In this embodiment, thehandle assembly 1908 may be dropped onto a proximal side of the firstlayer 1628 a (i.e., the elevator layer) after removal of the removablecap 1906.

FIGS. 20A-20B show detailed views of the handle assembly 1908 of theinstrument portion 1904 and the first layer 1628 a (i.e., the elevator)of the stage portion 1902, according to one or more embodiments.Referring first to FIG. 20A, illustrated is a bottom isometric view ofthe instrument handle assembly 1908 of the instrument portion 1904.Here, the handle assembly 1908 includes an engagement end 2002 arrangedto abut (or be in proximity to) the first layer 1628 a (FIG. 20B) whenthe carriage 1626 is assembled for use. As shown, the snaps 1632 extenddistally from the engagement end 2002, in a direction generallycorresponding with the direction of the shaft 1602. The snaps 1632 mayinclude a bulbous portion 2004 extending from a leg portion 2006, andmay be biased radially inward towards the shaft 1602, which may proveadvantageous in allowing each bulbous portion 2004 to be retained withincorresponding openings of the first layer 1628 a. As briefly mentionedabove, the snaps 1632 and their corresponding openings in the firstlayer 1628 a may be arranged to clock or angularly align the handleassembly 1908 relative to the stage portion 1902 (FIG. 20B), to therebysimplify proper installation.

FIG. 20B is an enlarged isometric view of the proximal end of the firstlayer 1628 a, according to one or more embodiments. In the illustratedembodiment, the first layer 1628 a is configured as an elevator having afloor 2010 (i.e., the elevator floor) fastened to a base 2012, and thecarriage nut 1634 may be constrained between the floor 2010 and the base2012. In some embodiments, the floor 2010 and the base 2012 may comprisean integral, monolithic part. In such embodiments, the carriage nut 1634may be formed between the floor 2010 and the base 2012. Alternatively,the carriage nut 1634 may be positioned or defined within one or both ofthe coaxially aligned screw apertures 2020 d defined in the floor 2010and the base 2012 and through which the lead screw 1622 extends.

As illustrated, the floor 2010 includes one or more openings 2014configured to align with corresponding bulbous portions 2004 (FIG. 20A)of each of the snaps 1632 (FIG. 20A). The openings 2014 correspond insize with the snaps 1632 such that they may receive and retain thebulbous portions 2004. The engagement end 2002 (FIG. 20A) may snap intothe floor 2010 of the first layer 1628 a (i.e., the elevator layer). Inparticular, the bulbous portions 2004 freely enter the correspondingopenings 2014 in the floor 2010 when the floor 2010 slides proximally toa position where the openings 2014 are not constrained by the shroud1640, but the bulbous portions 2004 are pressed into and retained in thecorresponding openings 2014 in the floor 2010 by the shroud 1640 as thefloor 2010 slides distally into shroud 1640. The shroud 1640 may helphold the snaps 1632 in an inward position where they are engaged by andretained within the corresponding openings 2014 in the floor 2010 of thefirst layer 1628 a. Thus, the handle assembly 1908 cannot separate fromthe floor 2010 until the floor 2010 travels to a proximal positionrelative to the shroud 1640 sufficient to allow the snaps 1632 todeflect radially outward to a position where the bulbous portions 2004are not retained within the corresponding openings 2014 of the floor2010. For example, the snaps 1632 of the handle assembly 1908 may beflared radially outward so as to slide into wider regions of thecorresponding openings 2014 in the floor 2010 when the first layer 1628a has been translated distally to a position where the correspondingopenings 2014 in the floor 2010 are not constrained by the shroud 1640,and then the shroud 1640 may force the snaps 1632 into narrower regionsof the corresponding openings 2014 as the handle assembly 1908 travelsdistally into the shroud 1640 to thereby lock the handle assembly 1908to the first layer 1628 a.

The splines 1624 a-c may extend at least partially through the carriage1626. In the illustrated embodiment, the splines 1624 a-c extend throughspline apertures 2020 a-c defined in the first layer 1628 a and the leadscrew 1622 extends through a screw aperture 2020 d also defined in thefirst layer 1628 a (see FIG. 20B). In addition, the handle assembly 1908includes spline passages 2022 a-c (spline passage 2022 c is occludedfrom view) and screw passage 2024 that extend through layers 1628 b-e,and optionally through the thrust bearing layer 1628 f, and align withthe spline apertures 2020 a-c and the screw apertures 2020 d of thefirst layer 1628 a such that the splines 1624 a-c and the lead screw1622 may extend through the handle assembly 1908 in addition to thefirst layer 1628 a. Also, the drive mechanisms of the associatedactivating mechanisms 1638 a-c may be keyed to the shape of the splines1624 a-c (FIG. 20A) so as to transmit rotation from the splines 1624a-c. Here, gears 2026 a-c (FIG. 20A) of the associated activatingmechanisms 1638 a-c each have bores 2028 keyed to the cross section ofthe associated spline 1624 a-c so as to transmit rotation from thespline 1624 a-c to the associated gear 2026 a-c.

In the illustrated example, the first layer 1628 a (i.e., the elevator)may include a central opening 2016 arranged to receive the shaft 1602and the end effector 1604 of the surgical tool 1600 as further describedbelow.

FIG. 21 illustrates how the handle assembly 1908 of the instrumentportion 1904 may be releasably attached to the stage portion 1902,according to one or more embodiments. In the illustrated embodiment, thehandle assembly 1908 is depicted in the process of being positioned onthe first layer 1628 a (i.e., the elevator floor) of the stage portion1902, with the shaft 1602 extending from the handle assembly 1908 andbeing inserted through the central opening 2016 of the first layer 1628a (i.e., the elevator). In some embodiments, the handle assembly 1908may be configured to assist engaging the stage portion 1902. Forexample, the lead screw 1622 may be threaded through a second carriagenut 2102 aligned with the screw passage 2024 and constrained within thehandle assembly 1908. Where included, the second carriage nut 2102 andor the screw passage 2024 may be utilized to help align (or clock) thehandle assembly 1908 with respect to the first layer 1628 a of the stageportion 1902, such that the splines 1624 a-c align with thecorresponding activating mechanisms 1638 a-c (FIG. 17), and the secondcarriage nut 2102 may further add stability when the handle assembly1908 is installed on the stage portion 1902. In addition, duringmanufacture the (first) carriage nut 1634 and the second carriage nut2102 can be aligned and engaged with the lead screw 1622 to help removeany drive slop that may otherwise exist in the surgical tool 1600 whenassembled.

In some embodiments, an alignment table 2104 may be utilized to helpalign the instrument portion 1904 with the stage portion 1902. FIG. 21illustrates the alignment table 2104 (hereinafter, “the table 2104”)when removed from the handle assembly 1908 of the instrument portion1904. In the illustrated embodiment, the table 2104 includes four legs2106 a-d that align with the spline passages 2022 a-c and the screwpassage 2024. Thus, the legs 2106 a-d may extend through theirrespective spline passages 2022 a-c and screw passage 2024, which mayhelp retain the associated activating mechanisms 1638 a-c, and also helpmaintain alignment of the respective spline passages 2022 a-c and screwpassage 2024 for receiving the splines 1624 a-c and the lead screw 1622.After connecting the handle assembly 1908 of the instrument portion 1904to the stage portion 1902, the table 2104 may be removed, and theremovable cap 1906 may then be secured on the shroud assembly 1700. Insome embodiments, the table 2104 includes just three of the legs 2106a-c which are associated with the splines 1624 a-c. In theseembodiments, the legs 2106 a-c are equal in length, such that each leg2106 a-c engages its associated spline 1624 a-c within the first layer1628 a (i.e., in the elevator floor) to maintain alignment therewithwhen the first layer 1628 a retracts to position and align splines 1624a-c with the associated activating mechanisms 1636 a-c (FIG. 17).

FIG. 22 illustrates the instrument portion 1904 being assembled on thestage portion 1902, according to one or more embodiments. Asillustrated, the table 2104 is assembled on the table handle assembly1908 of the instrument portion 1904 and the first layer 1628 a has beenmoved proximally to a location where the floor 2010 extends outward ofthe shroud 1640 to expose the openings 2014 for receipt of the snaps1632. By moving the first layer 1628 a proximally as shown, the openings2014 are not constrained in part by the shroud 1640 and the bulbousportions 2004 of the snaps 1632 may deflect and enter the openings 2014,thereby connecting the first layer 1628 a of the carriage 1626 to theother layers 1628 b-e of the carriage 1626, such that the carriage 1626is now assembled as an integral unit. When the carriage 1626 movesdistally into the shroud 1640 to a position where the floor 2010 islocated within the shroud 1640, the openings 2014 will be constrained bythe shroud 1640, such that the shroud 1640 retains the bulbous portions2004 of the snaps 1632 within the openings 2014 by inhibiting the snaps1632 from deflecting radially outward and separating from the openings2014, as described above.

FIG. 22 also illustrates how the table 2104 may be utilized to align thehandle assembly 1908 of the instrument portion 1904 with the stageportion 1902, according to one or more embodiments. As illustrated, thelegs 2106 a-d of the table 2104 may be positioned to extend within thespline passages 2022 a-c and the screw passage 2024, and may be used torotate the handle assembly 1908 into proper rotational alignment forreceiving the splines 1624 a-c and the lead screw 1622 of the stageportion 1902 of the surgical tool 1600. As the splines 1624 a-c and thelead screw 1622 enter their associated spline passages 2022 a-c andscrew passage 2024, they may engage a distal end of the correspondingleg 2106 a-d (of the table 2104) to move (or push) the table 2104 fromthe handle assembly 1908 as the handle assembly 1908 is pushedproximally onto the stage portion 1902. As a result, the table 2104 isgradually ejected and removed from the handle assembly 1908.

Removable Carriage Layers on Translating System

FIGS. 23A-23H illustrate example operation and modularity of thesurgical tool 1600 of FIG. 16, according to one or more embodiments. Inparticular, FIGS. 23A-23H depict an exemplary progression for installing(or interchanging) the instrument portion 1904 on the stage portion 1902of the surgical tool 1600.

Referring first to FIG. 23A, depicted is a proximal end 2302 of thestage portion 1902 of the surgical tool 1600 prior to installation ofthe instrument portion 1904 of the surgical tool 1600. The removable cap1906 is depicted as having been installed on the proximal end 2302 ofthe stage portion 1902. As mentioned herein, the first layer 1628 aprovides the elevator 2304 that is translationally driven and movablewithin the shroud 1640 along the longitudinal axis A₁, and, when thehandle assembly 1908 is installed on the elevator 2304, the elevator2304 carries the handle assembly 1908 as it translates axially. Here,the elevator 2304 is illustrated moving in a proximal direction towardsthe proximal end 2302, as indicated by arrow P.

FIG. 23B depicts the proximal end 2302 after the cap 1906 has beenremoved. By removing the cap 1906 from the shroud 1640, a user may gainaccess to an interior of the stage portion 1902 in which the elevator2304 resides and translates. After gaining access to the interior of thestage portion 1902, the user may install the instrument portion 1904 ofthe surgical tool 1600 on the elevator 2304, as described below. In atleast some embodiments, the user may continue moving the elevator 2304in a proximal direction, as indicated by the arrow P, to position whereat least a portion of the elevator 2304 protrudes or extends out of theshroud 1640.

FIG. 23C illustrates the elevator 2304 having been proximally moved intoa position where it partially protrudes from the shroud 1640. In thisillustration, the elevator 2304, which includes the floor 2010 and thebase 2012, has been moved proximally to where the floor 2010 ispositioned outside of the shroud 1640 while the base 2012 remains withinthe shroud 1640. By moving the elevator 2304 in this manner, theopenings 2014 in the floor 2010 are unconstrained by the shroud 1640 andopen at a periphery of the floor 2010 such that the snaps 1632 (FIGS.20A and 23E-23F) may be inserted therein, as generally described above.However, the elevator 2304 may be moved further proximally to where itfurther protrudes from the shroud 1640 or even fully protrudes from theshroud 1640.

The splines 1624 a-c may each extend the same distance. However, in someembodiments, at least some of the splines 1624 a-c extend at leastpartially through the elevator 2304 for engagement with the activatingmechanisms 1638 a-c (FIG. 22) of the handle assembly 1908 (FIG. 21) whenthe handle assembly 1908 is mounted to the floor 2010 of the elevator2304. Here, the second and third splines 1624 b-c protrude proximallyfrom the floor 2010 when the elevator 2304 is positioned in thisproximal position relative to the stage 1902 (FIGS. 23C-23D), whereasthe first spline 1624 a extends substantially flush with a face of thefloor 2010 but will protrude proximally from the face of the floor 2010when the elevator 2304 is moved distally (e.g., FIG. 23G). In otherembodiments, however, each of the splines 1624 a-c extends substantiallyflush with a face of the floor 2010 without protruding proximally fromthe face of the floor 2010 when the elevator 2304 is moved distally(e.g., FIG. 23G).

FIG. 23D illustrates the end effector 1604 of the instrument portion1904 being moved distally towards the elevator 2304, as indicated by anarrow D. The instrument portion 1904 of the surgical tool 1600 (FIG.20A) may be installed on the stage portion 1902 after moving theelevator 2304 into a position accessible to the handle assembly 1908(FIG. 22). In the illustrated embodiment, the elevator 2304 includes anopening 2306 sized to receive the end effector 1604 and the shaft 1602.The user may continue moving the instrument portion 1904 distally Dtowards the elevator 2304 and insert the end effector 1604 and shaft1602 of the instrument portion 1904 through the opening 2306 in theelevator 2304.

FIG. 23E illustrates the instrument portion 1904 being advanced onto thestage portion 1902, according to one or more embodiments. In particular,FIG. 23E illustrates the handle assembly 1908 after having inserted theend effector 1604 (FIG. 23D) and the shaft 1602 through the opening 2306in the elevator 2304 and after having moved the handle assembly 1908into a position proximate to the elevator 2304. In this embodiment, thetable 2104 is assembled on the handle assembly 1908 to help align theactivating mechanisms 1638 a-c (FIG. 22) of the instrument portion 1904with the splines 1624 a-c of the stage portion 1902. The user may holdthe table 2104 to advance and position the instrument portion 1904relative to the stage portion 1902. Regardless of whether the table 2104is utilized, the end effector 1604 and the shaft 1602 are advancedthrough the elevator 2304, and advanced distally through the stageportion 1902, through the first end 1618 a, and through the alignmentnozzle 1812 (FIG. 18B), as described above.

When the handle assembly 1908 is aligned with the elevator 2304, thesnaps 1632 will be in alignment with their corresponding openings 2014peripherally arranged about the floor 2010 (FIGS. 21-22), such that theinstrument portion 1904 may be attached to the stage portion 1902 (FIG.19). As mentioned above, the table 2104 may be utilized to align thestage portion 1902 and the instrument portion 1904 of the surgical tool1600 (FIGS. 21-22). The table 2104 may be utilized to rotate the handleassembly 1908 about the longitudinal axis A₁ (FIG. 21) into a positionwhere it is operatively aligned with the stage portion 1902. Forexample, the user may rotate the handle assembly 1908 into alignmentwith the elevator 2304 by rotating the table 2104 such that the firstleg 2106 a (FIG. 21) of the table 2104, which is arranged in the firstspline passage 2022 a (FIG. 21) defined in the handle assembly 1908,aligns with the first spline 1624 a (FIG. 21); such that the second leg2106 b (FIG. 21) of the table 2104, which is arranged in the secondspline passage 2022 b (FIG. 21) defined in the handle assembly 1908,aligns with the second spline 1624 b (FIG. 21); such that the third leg2106 c (FIG. 21) of the table 2104, which is arranged in the thirdspline passage 2022 c (FIG. 21) defined in the handle assembly 1908,aligns with the third spline 1624 c (FIG. 21); and such that the fourthleg 2106 d (FIG. 21) of the table 2104, which is arranged in the screwpassage 2024 (FIG. 21) defined in the handle assembly 1908, aligns withthe lead screw 1622 (FIG. 21).

The handle assembly 1908 may be further advanced onto the stage portion1902 and releasably secured on the stage portion 1902 as depicted inFIG. 23F. In particular, FIG. 23F illustrates the handle assembly 1908being further advanced onto the stage portion 1902 such that the snaps1632 engage or are otherwise received within corresponding openings 2014(FIG. 20B) in the floor 2010 (FIGS. 20A-20B). In this embodiment, thefloor 2010 of the elevator 2304 is positioned outside of the shroud 1640(FIG. 22), such that the shroud 1640 does not constrain the openings2014. In this manner, the snaps 1632 may enter the correspondingopenings 2014 in the floor 2010. For example, the openings 2014 mayinclude a chamfered lip configured to urge the bulbous portion 2004 ofthe snap 1632 outward as the snap 1632 is advanced into the opening2014, thereby causing the leg portion 2006 carrying the bulbous portion2004 to deflect (or flex) radially outward (FIG. 20A), and continualadvancement of the snap 1632 towards its opening 2014 will radiallyexpand the bulbous portion 2004 and the leg portion 2006 until thebulbous portion 2004 is in a position where the leg portion 2006 maybias (or snap) the bulbous portion 2004 within the opening 2014.Engagement of the snaps 1632 within their corresponding openings 2014results in the handle assembly 1908 being releasably secured on thestage portion 1902. At this time, the user may manually remove the table2104 (if utilized).

By coupling the handle assembly 1908 on the elevator 2304, the elevator2304 will carry the handle assembly 1908 as it translates along thelongitudinal axis A₁, such that the elevator 2304 and the handleassembly 1908 may translate together. As shown in FIG. 23G, the elevator2304 and the handle assembly 1908 carried thereby may be distallytranslated, as indicated by the arrow D, upon actuation of the leadscrew 1622. By retracting the elevator 2304 back within the shroud 1640,the inner wall of the shroud 1640 locks or traps the bulbous portions2004 of the snaps 1632 (FIG. 23E) within their corresponding openings2014 (FIG. 23C), such that the snaps 1632 may only be removed from theiropenings 2014 when the elevator 2304 is at least partially advanced outof the shroud 1640 (FIG. 23C).

The elevator 2304 and the handle assembly 1908, when secured together inthis manner, together define the carriage 1626. As the carriage 1626advances in the distal direction (arrow D), the splines 1624 a-c and/orthe lead screw 1622 may extend into and through the spline passages 2022a-c and/or the screw passage 2024 (FIGS. 21-22), and continual distaladvancement of the carriage 1626 may result in the table 2104 beingejected from the handle assembly 1908 as exemplified in FIG. 23G. Forexample, the splines 1624 a-c and the lead screw 1622 enter the splinepassages 2022 a-c and the screw passage 2024, respectively, as theelevator 2304 pulls the handle assembly 1908 distally, the proximal endsof the splines 1624 a-c and the lead screw 1622 (shown in FIGS. 23C-23D)will contact the ends of the legs 2106 a-d (FIG. 21) of the table 2104and thereby push the table 2104 out of the handle assembly 1908. Thus,the table 2104 may be automatically removed as the elevator 2304 pullsthe handle assembly 1908 distally. Finally, the cap 1906 may be placedback on the proximal end 2302 of the stage portion 1902. FIG. 23Hdepicts the cap 1906 re-installed on the proximal end 2302 of the stageportion 1902.

FIG. 23I is a schematic flowchart of an exemplary method 2310 forassembling and operating the surgical tool 1600 of FIG. 16), accordingto one or more embodiments. In the illustrated embodiment, the method2310 includes providing a surgical tool having a reusable stage portion,as at 2312, and then installing the reusable portion of the surgicaltool on a robotic instrument driver (e.g., the instrument driver 1102,1200, 1800 of FIG. 11, FIG. 12, and FIGS. 18A-18B, respectively), as at2314. As described herein, the reusable stage portion of the surgicaltool may have an elevator floor on which a removable handle portion ofsurgical tool may be mounted, and the elevator floor may be actuated tocarry the removable handle portion of the surgical tool in one or moredirections. The removable handle portion may include an end effectorthat translates with the elevator floor. The removable handle portion ofthe surgical tool may be mounted on the reusable stage portion prior toinstalling the reusable stage portion on the robotic tool drive or maybe mounted on the reusable stage portion after installing the reusablestage portion on the robotic tool drive.

In some embodiments, a method is provided for mounting the removablehandle portion of the surgical tool on the reusable stage portion, whichincludes providing the reusable stage portion with the elevator floor ina proximal position suitable for receiving the removable handle portion,and may sometimes also include positioning the elevator floor in theproximal position suitable for receiving the removable handle portionand removing a top cap of the surgical tool to expose the elevatorfloor. Thus, the method 2310 may include the step of mounting theremovable handle portion of the surgical tool on the reusable stageportion, as at 2316, and such step may further include either thesub-step of providing the reusable stage portion with the elevator flooralready in a suitable proximal position for receiving the removablehandle portion or the sub-steps of positioning the elevator floor in theproximal position suitable for receiving the removable handle portionand removing a top cap of the surgical tool to expose the elevatorfloor.

When in the proximal position, the removable handle portion may beoperatively mounted on the elevator floor such that drive input impartedin the reusable stage portion by the robotic tool drive is transferredto activating mechanisms in the removable portion configured to activateand/or move the end effector 1604. Drive input forces may be imparted onthe activating mechanisms of the removable portion via drive splines ofthe reusable stage portion and various configurations of the drivesplines incorporated in the reusable spline portion, for example,telescoping drive splines that extend or retract with movement of theelevator floor and/or fixed length drive splines.

In embodiments where the surgical tool includes a shroud assembly,operatively mounting the removable handle portion on the elevator floormay include dropping the removable handle portion through the shroudassembly and onto the elevator floor. After operatively mounting theremovable handle portion on the elevator floor, the removable cap may beplaced on a proximal end. Accordingly, after the mounting step 2316, themethod 2310 may include the step of using the surgical tool. During aprocedure, the removable handle portion may be removed from the reusablestage portion and optionally disposed of, and then a new removablehandle portion (e.g., having a different end effector or function) maybe operatively mounted on the elevator floor, for example, by droppingthe new removable handle portion onto the elevator floor through theshroud assembly. In this manner, the reusable stage portion is usable inmore than just one operation and/or on more than one patient, therebyjustifying the use and expense of components and materials inmanufacture that have superior durability, weight, and stiffness, etc.characteristics. Thus, the method 2310 may further include the steps ofremoving the removable handle portion of the surgical tool from thereusable stage portion, as at 2318, and installing (mounting) a newremovable handle portion of the surgical tool on the reusable stageportion, as at 2320.

Removable Endcap

In the embodiments described above, the splines 1624 a-c (FIG. 16) andthe lead screw 1622 (FIG. 16) extend between the first and second ends1618 a,b (FIG. 16). In these embodiments the splines 1624 a-c and thelead screw 1622 extend from the first end 1618 a, where they areoperatively connected to the drive inputs 1636 a-d of the surgical tool1600 that are matable with and driven by a corresponding drive output1824 a-f of the instrument driver 1800, such that movement (rotation) ofa given drive output 1824 a-f correspondingly moves (rotates) theassociated drive input 1636 a-d, which thereby moves (rotates) thesplines 1624 a-c and the lead screw 1622 associated therewith. Also inthese embodiments, the splines 1624 a-c and the lead screw 1622 extendand are operatively coupled to the cap 1906.

FIGS. 24A and 24B illustrate front and rear perspectives, respectively,of the cap 1906 of FIG. 19. In particular, FIG. 24A illustrates aninterior engagement side 2402 of the cap 1906, according to one or moreembodiments. The interior engagement side 2402 is configured to receivethe ends of the splines 1624 a-c and the lead screw 1622 when the cap1906 is installed, and also configured to permit uncoupling from thesplines 1624 a-c and the lead screw 1622 for removal of the cap 1906.Thus, the interior engagement side 2402 may include couplings(receptacles) for each of the splines and/or drive screws. In theillustrated embodiment, the interior engagement side 2402 includes threespline couplings 2404 a-c arranged to correspond with the three splines1624 a-c. However, the interior engagement side 2402 may include more orless than the three spline couplings 2404 a-c, for example, inembodiments having more or less than the three splines 1624 a-c. Thus,additional locations 2404 d-f may be configured to receive additionalsplines or drive elements. Here, hex head set screws 2405 are arrangedat the additional locations 2404 d-f as the illustrated embodimentutilizes the three spline couplings 2404 a-c. In addition, the interiorengagement side 2402 includes a stage coupling 2406 arranged tocorrespond with the drive screw 1622.

The spline couplings 2404 a-c and stage coupling 2406 are rotatablewithin the removable lid 1906, such that they rotate with theircorresponding spline 1624 a-c and lead screw 1622 when engaged therewithby installing the removable cap 1906. Also, any or all of the splinecouplings 2404 a-c and/or stage coupling 2406 may be keyed to the endgeometry of their corresponding splines 1624 a-c and/or lead screw 1622.In some embodiments, the splines 1624 a-c each include a square shapedend (not illustrated) and each spline coupling 2404 a-c includes arecess correspondingly shaped to receive the particular end geometry ofthe corresponding spline 1624 a-c, so as to ensure that the splinecouplings 2404 a-c rotate with their associated splines 1624 a-c whileminimizing relative slippage therebetween. It should be appreciated,however, that the splines 1624 a-c and the associated spline couplings2404 a-c may be keyed with other geometries (e.g., triangular,polygonal, ovoid, etc.) and that each associated spline and couplingpair may be keyed with a geometry different from one or more of theother associated spline and coupling pair, without departing from thepresent disclosure. Also in the illustrated embodiment, the stagecoupling 2406 is illustrated as a low friction thrust bearing keyed toan end geometry of the lead screw 1622. In other embodiments, however,the lead screw 1622 may be differently connected to the screw coupling2406, for example, in at least some embodiments, the lead screw 1622 maybe threaded into the screw coupling 2406.

In the illustrated embodiment, the removable cap 1906 further includes aframe assembly 2408 and a ring 2410 arranged about the frame assembly2408. The frame assembly 2408 is configured to retain the splinecouplings 2404 a-c and the stage coupling 2406. In some examples,additional spline couplings (e.g., similar to the spline couplings 2404a-c) may be arranged at the additional locations 2404 d-f with anorganization that comports with a standard alignment of splines suchthat the removable cap 1906 is utilizable with the maximum number ofsplines even where the handle assembly 1908 riding thereon may not beconfigured to receive input from one or more of the maximum number ofsplines.

The interior engagement side 2402 of the removable cap 1906 may beconfigured to mate with the shroud assembly 1700 (FIG. 17). In theillustrated example, the frame assembly 2408 includes a boss 2412protruding outward to define a plurality of alignment tabs 2414. Wheninstalling the removable cap 1906, the alignment tabs 2414 may be usedto ensure proper alignment by locating the alignment tabs 2414 withinthe corresponding alignment notches 1708 defined in the shroud 1640.

Telescoping Splines

FIGS. 25A and 25B are partial cross-sectional side views of one or moreexample embodiments of the splines 1624 a-c of FIGS. 16 and 17,according to embodiments of the present disclosure. In at least someembodiments, one or more of the splines 1624 a-c (and/or the lead screw1622) are configured to extend less than the entire distance between thefirst and second ends 1618 a,b. For example, rather than beingconstrained between the first end 1618 a and the removable cap 1906 asdescribed above, one or more of the splines 1624 a-c may be constrainedbetween the first end 1618 a and the carriage 1626. In theseembodiments, one or more of the splines 1624 a-c may be configured totelescope such that it/they expand or contract as the elevator 2304 ofthe carriage 1626 translates.

FIGS. 25A and 25B illustrate the splines 1624 a-c as telescopingstructures. In the illustrated embodiment, the splines 1624 a-c areconfigured to nest within a handle interface 2502 of the surgical tool1600 (FIG. 16). As illustrated, the handle interface 2502 is a structureof the surgical tool 1600 within which the one or more rotatable driveinputs (e.g., drive inputs 1636 a-d) are operatively arranged forreceiving input (e.g., rotational input) from the rotatable driveoutputs (e.g., drive outputs 1824 a-d) of the instrument driver 1800(FIG. 18B). Also, the splines 1624 a-c are operatively connected to thedrive inputs 1636 a-d within the handle interface 2502. Here, the handleinterface 2502 includes a floor 2504, and the splines 1624 a-c extendfrom their respective rotatable drive inputs 1636 a-d, upward throughthe floor 2504, and to the elevator 2304.

In the illustrated embodiment, the splines 1624 a-c each comprise aseries of telescoping portions 2506 configured to nest within the handleinterface 2502. FIG. 25A illustrates the carriage 1626 having beentranslated into a distal most position to thereby cause the telescopingportions 2506 of the splines 1624 a-c to substantially retract and nestwithin the handle interface 2502. In this manner, the splines 1624 a-cmay be in a retracted or nested condition where portions of the splines1624 a-c are nested beneath the floor 2504 when the elevator 2304 hastranslated into a distal most position.

FIG. 25B illustrates the elevator 2304 having been at least partiallytranslated in a proximal direction to thereby cause the series oftelescoping portions 2506 to telescope (or elongate, expand, extend,un-nest, etc.) into an at least partially extended state. In thismanner, one or more of the series of telescoping portions 2506 mayexpand (extend) through the floor 2504 and into a stage chamber 2508within which the carriage 1626 translates as the elevator 2304 pulls (orcarries, expands, telescopes, un-nests, etc.) the splines 1624 a-c intotheir extended state.

The series of telescoping portions 2506 may each include individualtelescoping spline portions 2510 a-d. The telescoping spline portions2510 a-d are operatively connected in series to transmit torque impartedon the rotatable drive inputs (e.g., the drive inputs 1636 b-d) by theinstrument driver 1800 to a coupling 2512. Thus, the telescoping splineportions 2510 a-d (of each spline 1624 a-c) may be rotationally fixedrelative to each other about an associated spline axis S₁, S₂, S₃. Inaddition, the telescoping spline portions 2510 a-d of each spline 1624a-c are serially connected such that they may telescope within eachother.

Here, the first telescoping spline portion 2510 a exhibits the largestdiameter, and the second telescoping spline portion 2510 b exhibits thesecond largest diameter and is slidingly retained within the firsttelescoping spline portion 2510 a. The third telescoping spline portion2510 c exhibits the third largest diameter and is slidingly retainedwithin the second telescoping spline portion 2510 b, and the fourthtelescoping spline portion 2510 d exhibits the fourth largest diameterand is slidingly retained within the third telescoping spline portion2510 c. In this manner, the fourth telescoping spline portion 2510 d mayslide into (or nest within) the third telescoping spline portion 2510 c,the third telescoping spline portion 2510 c may slide into (or nestwithin) the second telescoping spline portion 2510 b, the secondtelescoping spline portion 2510 b may slide into (or nest within) thefirst telescoping spline portion 2510 a, and the telescoping splineportions 2510 a-d may nest together as the elevator 2304 moves distallytowards the floor 2504. Here, the telescoping spline portions 2510 a-dnest in the handle interface 2502 such that the splines 1624 a-c areconcealable within the handle interface 2502, but in other embodiments,they may be differently configured, for example, to nest within theelevator 2304.

In some embodiments, the coupling 2512 may include a receptacle 2514configured to transmit torque to a corresponding activating mechanism1638 a-c configured to drive and cause operation of specific functionsof the end effector 1604. In some embodiments, removable splines 2516a-c may be provided in the handle assembly 1908 for receiving driveinput from the couplings 2512 and transmitting that imparted torque tothe associated activating mechanisms 1638 a-c, such that torque impartedby the instrument driver 1800 (FIGS. 18A-18B) is operatively transferredto the handle assembly 1908 to permit various movements and actions ofthe end effector 1604. Here, the removable splines 2516 a-c may eachinclude a torsion shaft 2520 having an input end 2522 positioned tocommunicate or mate with the coupling 2512 via the receptacle 2514,which may rotationally lock the torsion shaft 2520 of each removablespline 2516 a-c with the associated coupling 2512 and series oftelescoping portions 2506. For example, the receptacle 2514 may be keyedto the particular spline geometry of the input end 2522 associated withit. Also, each torsion shaft 2520 may include an output 2524 in operableengagement with the associated activating mechanisms 1638 a-c. In someexamples, the output 2524 is an output or drive gear that isrotationally fixed on the torsion shaft 2520 such that they rotate inunison.

FIG. 25B depicts the carriage 1626 partially disassembled (i.e., withthe handle assembly 1908 partially removed from the elevator 2304), soas to more fully illustrate orientation and interaction of componentswithin the handle assembly 1908. For example, FIG. 25B illustrates thetelescoping nature of the series of telescoping portions 2506, theorientation of the removable splines 2516 a-c and the associatedactivating mechanisms 1638 a-c, engagement of the removable splines 2516a-c of the handle assembly 1908 with the couplings 2512 of the elevator2304, etc. In this example, the first layer 1628 a is the elevator 2304on which the structural layers 1628 b-d are releasably attachable and isassociated with controlling axial translation of the carriage of thesurgical tool 1600. The second layer 1628 b is the bottom layer of thehandle assembly 1908 and is associated with controlling a firstfunctionality of the end effector 1604, the third layer 1628 c is themiddle layer of the handle assembly 1908 and is associated withcontrolling a second functionality of the end effector 1604, and thefourth layer 1628 d is the upper layer of the handle assembly 1908 andis associated with controlling a third functionality of the end effector1604.

In the illustrated example, the shroud 1640 is illustrated as a rigidtube member that does not expand or contract. Thus, in some examples thestage chamber 2508 defined by the shroud 1640 may be of fixed volume.However, in other examples, the shroud 1640 may be configured to expandor contract with movement of the elevator 2304 and telescoping splines1624 a-c. For example, the shroud 1640 may comprise a series oftelescoping shroud portions arranged to telescope between nested andun-nested positions with movement of the elevator 2304.

FIGS. 26A and 26B illustrate the splines 1624 a-c configured totelescope, according to one or more alternate embodiments of the presentdisclosure. In the illustrated embodiment, the splines 1624 a-c areprovided as a series of telescoping spline members 2602 arranged totelescope from a nested or retracted position (FIG. 26A) into one ormore extended positions (FIG. 26B). Thus, in this example, the splines1624 a-c are concealable within the elevator 2304.

Here, the series of telescoping spline members 2602 are configured totelescope into the elevator 2304. For example, each of the series oftelescoping portions 2602 may include individual telescoping splineportions 2604 a-d. The telescoping spline portions 2604 a-d areoperatively connected in series to transmit torque imparted on therotatable drive inputs (e.g., the drive inputs 1636 b-d) by theinstrument driver 1800 to a coupling 2606. Thus, the telescoping splineportions 2604 a-d (of each spline 1624 a-c) may be rotationally fixedrelative to each other about an associated spline axis S₁, S₂, and S₃.In addition, the telescoping spline portions 2604 a-d (of each spline1624 a-c) are serially connected such that they may telescope withineach other.

Here, the first telescoping spline portion 2604 a exhibits the largestdiameter and is at least partially arranged in or otherwise coupled tothe elevator 2304, and the second telescoping spline portion 2604 bexhibits the second largest diameter and is slidingly retained withinthe first telescoping spline portion 2604 a. The third telescopingspline portion 2604 c exhibits the third largest diameter and isslidingly retained within the second telescoping spline portion 2604 b,and the fourth telescoping spline portion 2604 d exhibits the fourthlargest diameter and is slidingly retained within the third telescopingspline portion 2604 c. In this manner, the fourth telescoping splineportion 2604 d may slide into (or nest within) the third telescopingspline portion 2604 c, the third telescoping spline portion 2604 c mayslide into (or nest within) the second telescoping spline portion 2604b, the second telescoping spline portion 2604 b may slide into (or nestwithin) the first telescoping spline portion 2604 a, and the telescopingspline portions 2604 a-d may nest together as the elevator 2304 movesdistally towards the floor 2504. Thus, the telescoping spline portions2604 a-d are shown configured to nest in the first frame layer 1628 a(i.e., the elevator layer 2304), but in other embodiments they may beconfigured to nest differently.

In some embodiments, the lead screw 1622 is a rigid member having anon-telescoping configuration. In other embodiments, however, the leadscrew 1622 may be configured to telescope with the elevator 2304. Forexample, the lead screw 1622 may be a telescoping linear actuator havinga centermost telescoping member terminating on the first layer 1628 a(i.e., the elevator floor).

FIG. 27 is a top, cross-sectional view of a telescoping splineconfiguration 2700 according to one or more additional embodiments. Thesplines 1624 a-c (FIGS. 26A-26B) may have varying telescopingconfigurations, such as the telescoping spline configuration 2700exemplified in FIG. 27. In the illustrated embodiment, the telescopingspline configuration 2800 includes a series of concentric splineportions having corresponding keyed geometries, so as to rotate togetherand transmit a torsional force through the telescoping splineconfiguration 2800.

FIGS. 28A-28B illustrate an expandable and collapsible shroud 2802 inrespective collapsed and expanded positions, according to one or moreembodiments. As mentioned above, the shroud 1640 may be configured toexpand or contract with the elevator 2304. In the illustratedembodiment, the expandable and collapsible shroud 2802 includes anexpandable portion 2804 arranged to expand or contract with the elevator2304. The expandable portion 2804 may have various configurations, suchas a bellows or accordion-like configuration, a telescopingconfiguration, etc.

Drive Puck for Translating System with Mapped Instrument Drive Outputs

FIG. 29 illustrates an elevator of the surgical tool 1600 that operatesas a translatable drive puck (or nut) 2900, according to one or moreembodiments of the present disclosure. In these embodiments, the drivepuck 2900 not only functions as a stage for the surgical tool 1600, butalso maps or transfers (e.g., via gearing) input forces received fromthe splines 1624 a-c to predetermined drive locations within theenvelope of the shroud 1640 that do not correspond (or are unassociated)with locations of the associated splines 1624. As will be appreciated,this can allow utilization of differently shaped shrouds or shroudassemblies.

As illustrated, the drive puck 2900 is configured to translate on thesplines 1624 a-c within the shroud 1640 and transfer drive input forcesreceived therefrom to off-set or remote drive output locations. Thedrive puck 2900 rides or slides on the splines 1624 a-c within theshroud 1640 and is thus a translatable drive puck that may function asthe stage (elevator) of the surgical tool 1600. In the illustratedexample, the drive puck 2900 translates along the splines 1624 a-c viaactuation of the lead screw 1622. Thus, the drive puck 2900 may includea drive screw portion (obscured from view) that intermeshes with thelead screw 1622. In some embodiments, for example, the carriage nut 1634(FIG. 16) may be constrained within a body 2902 of the drive puck 2900.However, in other examples, a threaded bore 2904 (occluded, see FIGS.30A-30B and FIG. 31) may be formed in the body 2902 and configured toreceive the lead screw 1622 and cause translation of the drive puck 2900upon rotation of the lead screw 1622.

While the drive puck 2900 is configured to translate axially within theshroud 1640, rotation of the drive puck 2900 within the shroud 1640 isinhibited. In the illustrated example, the drive puck 2900 defines orotherwise provides one or more guide notches 2906 sized to receive therails 1704 such that the rails 1704 may ride within the notches 2906 asthe drive puck 2900 translates within the shroud 1640. Consequently, therails 1704 guide the drive puck 2900 as it translates axially within theshroud 1640 and also constrain the drive puck 2900 from rotating bycountering any rotational forces acting on the drive puck 2900. In thismanner, any rotational force acting on the drive puck 2900 will beassumed by the rails 1704, such that the rotational force is notimparted to the splines 1624 a-c extending through the drive puck 2900.

As illustrated, the splines 1624 a-c extend through the drive puck 2900and the drive puck 2900 is able to slide on or otherwise axiallytraverse the splines 1624 a-c. Here, the drive puck 2900 is illustratedand described as being operable with three of the splines 1624 a-c,however, the drive puck 2900 may be differently configured so that it isoperable using input from any number and/or arrangement of splines. Thedrive puck 2900 may translate on the splines 1624 a-c both when thesplines 1624 a-c are stationary and when one or more of the splines 1624a-c are activated (i.e., rotated via the instrument driver 1800). Toaccomplish this, as illustrated, the drive puck 2900 may include splinecouplings 2910 a-c that correspond with the splines 1624 a-c and arerotatable with the associated spline 1624 a-c. Here, the first spline1624 a extends through the first spline coupling 2910 a, the secondspline 1624 b extends through the second spline coupling 2910 b, and thethird spline 1624 c extends through the third spline coupling 2910 c.The spline couplings 2910 a-c may each include an interior geometryconfigured to engage and mate with the geometry of the associated spline1624 a-c. In some embodiments, the spline couplings 2910 a-c may eachinclude a geometry keyed to the cross-section of the associated spline1624 a-c. In the illustrated embodiments, the spline couplings 2910 a-ceach define (exhibit) a square-shaped geometry matable with theassociated spline 1624 a-c such that rotation of the spline 1624 a-ccorrespondingly rotates the associated spline coupling 2910 a-c.

According to embodiments of the present disclosure, the drive puck 2900may be configured such that the spline couplings 2910 a-c transfer driveinput forces to locations on the drive puck 2900 that are distant orpositioned away (laterally offset) from the spline couplings 2910 a-c.In particular, the spline couplings 2910 a-c receive drive input forcesfrom the associated splines 1624 a-c, and internal gearing within thedrive puck 2900 maps or transmits those drive input forces tocorresponding drive outputs (e.g., drive pegs) at locations that do notcorrespond (align) with the spline couplings 2910 a-c and the associatedsplines 1624 a-c. Thus, the drive puck 2900 may receive drive input fromthe splines 1624 a-c extending through an input region of the drive puck2900 and transfer that drive input to any output region of the drivepuck 2900 that is positioned away from the input region and configuredto receive a removable handle drive assembly of the surgical tool 1600as described herein.

In the illustrated example, the drive puck 2900 is cylindricallycircular in shape and thus includes a generally circular proximal face(see FIG. 30A) and a generally circular distal face (see FIG. 30B).Here, the spline couplings 2910 a-c are arranged on a first arcuateportion (e.g., a first half-arc-length) of the circular shaped distaland proximal faces of the drive puck 2900. In addition, the drive puck2900 includes one or more instrument drive outputs 2912 a-c operativelyconnected with an associated one of the spline couplings 2910 a-c. Here,the instrument drive outputs 2912 a-c comprise drive pegs and arearranged on a second arcuate portion (e.g., a second half-arc-length) ofthe drive puck 2900. In one example, the instrument drive outputs 2912a-c are provided as drive pegs with stub shafts extending (orprotruding) outward from the proximal face of the drive puck 2900.

In the illustrated example, the first spline coupling 2910 a isoperatively connected to the first instrument drive output 2912 a suchthat rotation of the first spline coupling 2910 a (via the first spline1624 a) rotates the first instrument drive output 2912 a. The secondspline coupling 2910 b is operatively connected to the second instrumentdrive output 2912 b such that rotation of the second spline coupling2910 b (via the second spline 1624 b) rotates the second instrumentdrive output 2912 b. The third spline coupling 2910 c is operativelyconnected to the third instrument drive output 2912 c such that rotationof the third spline coupling 2910 c (via the third spline 1624 c)rotates the third instrument drive output 2912 c. As more fullydescribed below, internal gearing may be provided within the drive puck2900 to operatively intermesh each of the spline couplings 2910 a-c withthe instrument drive output 2912 a-c associated therewith. In thismanner, the drive puck 2900 receives drive input forces through thespline couplings 2910 a-c interacting with the splines 1624 a-c in thefirst hemisphere, and internal gearing within the drive puck 2900transfers (or maps) each drive input force to one of the instrumentdrive outputs 2912 a-c located in the second hemisphere. Thus, theinstrument drive outputs 2912 a-c may be arranged at locations about thedrive puck 2900 that are independent of the orientation of the splines1624 a-c and/or at locations about the drive puck 2900 that do notcorrespond with the particular location(s) at which their associatedsplines 1624 a-c engage the drive puck 2900.

FIGS. 30A and 30B are isometric top and bottom views, respectively, ofthe drive puck 2900 of FIG. 29, according to one or more embodiments.More specifically, FIG. 30A depicts a first or “proximal” face 3002, andFIG. 30B depicts a second or “distal” face 3004 opposite the proximalface 3002. As illustrated, the drive puck 2900 defines a centralaperture or bore 3006 extending through the body 2902 between theproximal and distal faces 3002, 3004. The bore 3006 may be sized toreceive the shaft 1602 of the surgical tool 1600 (FIG. 16) when a handledrive assembly is installed thereon. In the illustrated embodiment, thebody 2902 is hollow and defines an interior volume 3008 that is incommunication with the bore 3006.

In some embodiments, as illustrated, the spline couplings 2910 a-c mayinclude stub portions 3010 that extend or protrude from at least theproximal face 3002 of the body 2902. In other examples, one or more ofthe stub portions 3010 may instead be arranged to extend from the distalface 3004 and/or to extend from both the proximal and distal faces 3002,3004. The stub portions 3010 each define a receptacle 3012 through whichthe corresponding splines 1624 a-c can extend to slidingly engage. Alsoin the illustrated example, each of the instrument drive outputs 2912a-c includes a stub shaft 3014 extending or protruding past the proximalface 3002 and configured to mate with a mating shaft receptacle.

FIG. 31 is an isometric top view of the drive puck 2900, according toone or more embodiments. The body 2902 is shown in phantom in FIG. 31 soas to better illustrate how the spline couplings 2910 a-c may be inoperative engagement with the instrument drive outputs 2912 a-c,according to some embodiments. As briefly mentioned above, variousgearing and/or mechanisms may be arranged within the body 2902 tooperatively intermesh and/or couple each of the spline couplings 2910a-c with the associated instrument drive output 2912 a-c. Asillustrated, each of the spline couplings 2910 a-c includes a drive gear3020 a-c arranged within the interior volume 3008 of the body 2902.Here, each of the drive gears 3020 a-c is integrally formed with itsassociated spline coupling 2910 a-c, but the drive gears 3020 a-c may bedifferently connected to their respective spline coupling 2910 a-c. Inaddition, each of the instrument drive outputs 2912 a-c includes adriven gear 3022 a-c. Here, each of the driven gears 3022 a-c isintegrally formed with its associated instrument drive output 2912 a-c,but the driven gears 3022 a-c may be differently connected to itsrespective instrument drive output 2912 a-c.

In some embodiments, the drive puck 2900 may further include first andsecond idler gears 3024 a and 3024 b to operatively couple the first andsecond spline couplings 2910 a,b with the first and second instrumentdrive outputs 2912 a,b, respectively. In the illustrated embodiment, thefirst and second idler gears 3024 a,b are arranged within the body 2902.As illustrated, the first idler gear 3024 a interposes and intermesheswith both the first drive gear 3020 a and the first driven gear 3022 aof the first instrument drive output 2912 a. In this manner, rotation ofthe first spline 1624 a causes the first spline coupling 2910 a and thefirst drive gear 3020 a to rotate, which causes the first idler gear3024 a to rotate and drive the first driven gear 3022 a and the firstinstrument drive output 2912 a. Similarly, the second idler gear 3024 binterposes and intermeshes with both the drive gear 3020 b of the secondspline coupling 2910 b and the driven gear 3022 b of the instrumentdrive output 2912 b. In this manner, rotation of the second spline 1624b causes the second spline coupling 2910 b and the second drive gear3020 b to rotate, which causes the second idler gear 3024 b to rotateand drive the second driven gear 3022 b and the instrument drive output2912 b.

In the illustrated embodiment, the drive puck 2900 also includes a ringgear 3026 arranged to operatively couple the third spline coupling 2910c with the third instrument drive output 2912 c. In other embodiments,however, the third spline coupling 2910 c and the third instrument driveoutput 2912 c may be operatively coupled via a different means, forexample, via an idler gear as described above. Where utilized, the ringgear 3026 is arranged to mesh with both the third drive gear 3020 c ofthe third spline coupling 2910 c and the third driven gear 3022 c of thethird instrument drive output 2912 c. Here, the ring gear 3026 ismounted within the interior volume 3008 of the body 2902 such that thering gear 3026 is able to rotate relative to the body 2902. Asillustrated, the ring gear 3026 extends continuously along an innercircumferential wall of the body 1902 such that it intermeshes with boththe drive gear 3020 c and the driven gear 3022 c. In this manner,rotation of the third spline 1624 c and the third spline coupling 2910 crotates the third drive gear 3020 c, which in turn causes the ring gear3026 to rotate and drive the driven gear 3022 c meshed therewith tothereby cause rotation of the third instrument drive output 2912 c.

Thus, the drive puck 2900 may be configured to travel along the splines1624 a-c and receive the splines 1624 a-c at respective spline openingslocated at a distal (e.g., bottom) side of the body 2902, and transferthe torsional forces (torque) from the splines 1624 a-c to thecorresponding instrument drive outputs 2912 a-c arranged on an oppositeproximal (e.g., top) side of the body 2902 at locations spaced away (oroffset) from the associated splines 1624 a-c.

FIG. 32 illustrates a portion of the surgical tool 1600 (FIG. 16),according to one or more embodiments. In the illustrated embodiment, thesurgical tool 1600 may be segmented into different portions or segments.For example, the surgical tool 1600 may include a stage segment (FIG.29), which incorporates the drive puck 2900 and its functionality, andmay further include a handle segment 3200 mountable to the drive puck2900 and operatively connected to both the shaft 1602 and the endeffector 1604 for actuating the same. The handle segment 3200, the shaft1602, and the end effector 1604 may all be integrated together as a unitthat may be removed from the stage segment, such that a new unit may beinstalled on the same stage segment. Accordingly, the handle segment3200, the shaft 1602, and the end effector 1604 may all be integratedtogether to as a removable segment of the surgical tool 1600, which maybe installed and uninstalled from the stage segment (FIG. 29) andreplaced with a new removable segment.

In the illustrated embodiment, the handle segment 3200 includes a handledrive housing 3202 having a mounting surface 3204 configured to bemounted on or otherwise mate with the proximal face 3002 (FIG. 30A) ofthe drive puck 2900 (FIG. 29). In particular, the mounting surface 3204is configured to mate with and engage the instrument drive outputs 2912a-c (FIG. 30A). Thus, the handle drive housing 3202 and the mountingsurface 3204 may include geometries corresponding with at least aportion of the drive puck 2900. The housing 3202 is depicted in FIG. 32in phantom so as to illustrate the various activating mechanismscontained within the housing 3202.

FIG. 33 is an enlarged isometric view of the handle segment 3200 withthe housing 3202 shown in phantom to further illustrate exemplaryoperation, according to one or more embodiments. A plurality of driveinputs 3206 a-c are provided or otherwise defined in the mountingsurface 3204. In the illustrated example, three drive inputs 3206 a-care provided to communicate with and engage the instrument drive outputs2912 a-c (FIG. 30A) of the drive puck 2900 (FIG. 29), and therebyactuate the end effector 1604. However, more or less than three driveinputs 3206 a-c may be provided if the drive puck 2900 includes more orless than three instrument drive outputs 2912 a-c. As illustrated, eachdrive input 3206 a-c defines or otherwise provides a receptacle having ageometry that corresponds to the geometry of the associated instrumentdrive output 2912 a-c so as to be able to transfer torsional forces(torque) therebetween.

The first drive input 3206 a may be operatively coupled to or form partof the first activating mechanism 1638 a, which operates to open andclose the jaws 1610, 1612. Accordingly, rotating the first drive input3206 a will correspondingly actuate the first activating mechanism 1638a and thereby open or close the jaws 1610, 1612, depending on therotational direction of the first instrument drive output 2912 a.Similarly, the second drive input 3206 b may be operatively coupled tothe second activating mechanism 1638 b, which operates to articulate theend effector 1604 at the wrist 1606. Accordingly, rotating the seconddrive input 3206 b will correspondingly actuate the second activatingmechanism 1638 b and cause the wrist 1606 to articulate in at least onedegree of freedom, depending on the rotational direction of the secondinstrument drive output 2912 b. In addition, the third drive input 3206c may be operatively coupled to the third activating mechanism 1638 c,which operates to fire the cutting element at the end effector 1604.Accordingly, rotating the third drive input 3206 c will correspondinglyactuate the third activating mechanism 1638 c and cause the knife toadvance or retract, depending on the rotational direction of the thirdinstrument drive output 2912 c.

In the illustrated embodiment, the drive inputs 3206 a-c each include arespective shaft 3210 a-c that extends proximally into the housing 3202and is connected to a respective drive gear 3212 a-c. Also, each drivegear 3212 a-c is arranged to engage the activating mechanism 1628 a-cassociated with it. Alternatively, as indicated above, the drive gears3212 a-c may each form an integral part of the corresponding activatingmechanism 1628 a-c.

Here, the first drive gear 3212 a is intermeshed with a driven gear 3214of the first activating mechanism 1638 a. The driven gear 3214 may beinternally threaded and arranged about an externally threaded portion ofthe shaft 1602, such that rotation of the internally threaded drivengear 3214 via rotation of the first drive inputs 3206 threadably engagesthe externally threaded portion of the shaft 1602 and thereby drives theshaft 1602 axially to open and/or close the jaws 1610, 1612 (FIG. 32).The second drive gear 3212 b may be arranged to engage a pinion or idlergear 3216, which is operatively intermeshed between the second drivegear 3212 b and a driven gear 3218 of the third activating mechanism1638 c to thereby effectuate firing of the cutting means of end effector1604. The third drive gear 3212 c may be arranged to intermesh with apair of internally threaded driven gears 3220 a,b of the secondactivating mechanism 1638 b. The pair of internally threaded drivengears 3220 a,b have opposite thread patterns and are arranged aboutcorresponding threaded carriers 3224 a and 3224 b, which translate inopposing axial directions upon rotation of the internally threadeddriven gears 3220 a,b. This causes a pair of linearly translatableinternal drive rods 3226 a (one shown) to antagonistically move distallyor proximally. The internal drive rods 3226 a are operatively coupled tothe wrist 1606, and the antagonistic push and pull of the drive rodsoperate to control articulation of the wrist 1606.

FIG. 34 illustrates an exemplary alignment between the handle segment3200 and the drive puck 2900 when installing the removable segment ofthe surgical tool 1600, according to one or more embodiments. In theillustrated embodiment, the first instrument drive output 2912 a isalignable and matable with the first drive input 3206 a, the secondinstrument drive output 2912 b is alignable and matable with the seconddrive input 3206 b, and the third instrument drive output 2912 c isalignable and matable with the third drive input 3206 c. Moreover, theshaft 1602 is extendable through the bore 3006.

As discussed above, the drive inputs 3206 a-c are driven by theinstrument drive outputs 2912 a-c, which are driven indirectly fromlocations corresponding with the splines 1624 a-c with internal gearing.In other examples, the drive puck 2900 may include just two instrumentdrive outputs 2912 driven indirectly from their associated splines withinternal gearing. Moreover, in some of these examples, the drive puck2900 may also be configured to permit direct drive of the handle segment3200. For example, the handle segment 3200 may have two or more inputscorresponding with and driven by the indirectly driven elevator outputsof the drive puck 2900, and the handle segment 3200 may also include oneor more inputs each directly activated by an additional spline(unaffiliated with an indirectly driven elevator output), such that twoor more inputs of the handle segment 3200 are indirectly driven by thedrive puck 2900 and one or more other inputs of the handle segment 3200are directly driven by splines.

Accordingly, the drive puck 2900 transfers (or maps) the drive positionof the handle segment portion 3200 to locations offset from (orunassociated or unaligned with) the splines 1624 a-c. While the drivepuck 2900 has been described with reference to gearing that mechanicallyconnects the splines 1624 a-c with the associated instrument driveoutputs 2912 a-c, different means may be utilized to transfer input ofthe splines 1624 a-c to the instrument drive outputs 2912 a-c. Forexample, the splines 1624 a-c may be mechanically connected to theinstrument drive outputs 2912 a-c with belts or other mechanisms.Locating the instrument drive outputs 2912 a-c at drive positionsunassociated with the splines 1624 a-c to which they are mechanicallyconnected provides greater flexibility when designing the geometry ofthe handle segment portion 3200 and/or the shroud 1640.

FIG. 35 illustrates the surgical tool 1600 with the handle segment 3200installed on the drive puck 2900 of the stage segment. Here, the shaft1602 is extended through the bore 3006 in the drive puck 2900 and themounting surface 3204 of the handle drive housing 3202 (FIG. 34) ispositioned on the proximal face 3002 (FIG. 34) of the drive puck 2900.In particular, the handle segment 3200 is positioned on the drive puck2900 such that the drive inputs 3206 a-c are in alignment with theinstrument drive outputs 2912 a-c of the drive puck 2900.

Surgical Tool with Removable Instrument Core

FIG. 36 illustrates another example embodiment of the surgical tool1600, according to various embodiments. As mentioned above, the surgicaltool 1600 may be assembled by removing the removable cap 1906 and thenmounting the handle segment 3200 (FIG. 32) on the drive puck 2900 (FIG.29), which functions as the stage portion 1902 (FIG. 19) of the surgicaltool 1600, as exemplified in FIGS. 34-35. In other embodiments, thesurgical tool 1600 may be configured such that at least a portion of theinstrument portion 1904 (FIG. 19) is an interchangeable sub-assembly (orcore) that may be installed on the stage portion 1902. For example, thehandle assembly 1908, the elongated shaft 1902, and the end-effector1604 of the removable instrument portion 1904 may be integrated togetheras an interchangeable core of the surgical tool 1600 that may be droppedstraight onto (or angled onto) the stage portion 1902 without having toremove the removable cap 1906.

In FIG. 36, the surgical tool 1600 includes or otherwise incorporates ahandle sub-assembly or handle core 3602 configured to be dropped orangled (or arced) into (i.e., installed in) a stage sub-assembly 3604.In this illustration, the shroud 1640 (FIG. 17) has been removed so asto more easily illustrate the stage sub-assembly 3604. The handle core3602 (hereinafter, the core 3602) is an assembly that generallycomprises the instrumentation componentry and therapeutic and/ordiagnostic features of the surgical tool 1600. Thus, as illustrated, thecore 3602 may include the shaft 1602, the end effector 1604, and theoperational engagement features configured to affect movement andfunctionality of the end effector 1604 when engaged by the stagesub-assembly 3604.

In the illustrated embodiment, the stage sub-assembly 3604 includes acarriage or kart 3606 configured to translate between the first andsecond ends 1618 a,b. Thus, the carriage 3606 may include a carriage nutor kart nut (obscured from view) that is operatively engaged with thelead screw 1622 such that rotation of the lead screw 1622 translates thecarriage 3606 along the lead screw 1622. The splines 1624 a-c may bearranged within a lower half (e.g., 180°) of the stage sub-assembly 3604and extend through the carriage 3606. Thus, the carriage 3606 mayinclude spline channels extending therethrough for receiving the splines1624 a-c such that the splines 1624 a-c may rotate within the splinechannels as the carriage 3606 translates along the lead screw 1622. Asmore fully described below, spline couplings may be arranged within eachof the spline channels, where the spline couplings each receive acorresponding spline 1624 a-c such that they rotate in unison with theirrespective spline 1624 a-c, and the spline couplings are axiallyconstrained within their respective spline channels such that the splinecouplings may slide along the splines 1624 a-c as the carriage 3606axially translates.

In addition, the stage sub-assembly 3604 includes a pair of guide rails3608 a,b extending between the first and second ends 1618 a,b. The guiderails 3608 a,b extend substantially parallel with the splines 1624 a-cof the stage sub-assembly 3604, and help facilitate installation of thecore 3602 on the carriage 3606. Moreover, the guide rails 3608 a,b guidethe core 3602 as it is carried by the carriage 3606 when translatingproximally or distally between the first and second ends 1618 a,b. Inthis example, the guide rails 3608 a,b are unconstrained by the carriage3606. More specifically, the carriage 3606 is generally U-shaped anddefines a trough 3610 (or space or void) sized and shaped to receive thecore 3602 in a nested relationship and also constrain the core 3602installed therein such that the carriage 3606 carries the core 3602 asthe carriage 3606 translates between the first and second ends 1618 a,b.

Also in the illustrated embodiment, the core 3602 includes a pair ofarms or wings 3612 a,b laterally extending from a drive housing or body3614 of the core 3602, where the arms 3612 a,b are configured to bereleasably attached to the guide rails 3608 a,b. In some embodiments,the arms 3612 a,b rest on the guide rails 3608 a,b. In some embodiments,the arms 3612 a,b may be configured to slidingly snap onto the guiderails 3608 a,b when the body 3614 of the core 3602 is positioned in thetrough 3610 in the carriage 3606, such that the arms 3612 a,b retain thebody 3614 on the rails 3608 a,b while translating between the first andsecond ends 1618 a,b. In some embodiments, the arms 3612 a,b may includelocking toggle levers configured to slidingly attach the arms 3612 a,bon the guide rails 3608 a,b when the body 3614 of the core 3602 ispositioned in the trough 3610 in the carriage 3606. In some embodiments,the arms 3612 a,b include semicircular closure members that rotate andclose around the rails 3608 a,b upon activation of a locking switch. Inone non-illustrated embodiment, one or more of the drive splines operateas the guide rail on which the core 3602 is positioned, for example, thearms 3612 a,b may be attachable on the first and second spline 1624 a,bthat engage a respective drive function, such as the drive gears 3212a-c (FIG. 33).

FIG. 37 is a schematic diagram depicting example installation of thecore 3602 to the stage sub-assembly 3604 of FIG. 36. As illustrated, thecore 3602 may be dropped on or angled into the stage sub-assembly 3604.As the core 3602 descends, the arms 3612 a,b may be aligned to receivethe guide rails 3608 a,b, and thus resting the core 3602 on the guiderails 3608 a,b. In addition, the body 3614 includes operative engagementfeatures for actuating the shaft 1602 (FIG. 36) and the end effector1604 (FIG. 36). In the illustrated examples, the core 3602 is configuredto interface with the spline couplings within the carriage 3606 so as tocontrol operation of the end effector 1604. For example, the carriage3606 may slide on the splines 1624 a-c with gears within the carriagedriven by and translating on the splines 1624 a-c that interface withthe operative engagement features in the body 3614, such as the drivegears 3212 a-c (FIG. 33).

FIGS. 38 and 39 illustrate another example of the surgical tool 1600incorporating a handle sub-assembly or handle core 3802 configured to bedropped into a stage assembly 3902, according to various embodiments. InFIG. 38, the core 3802 is illustrated when removed from the stageassembly 3902 (FIG. 39), whereas FIG. 39 illustrates the stage assembly3902 without the core 3802 (FIG. 38) installed therein. The handle core3802 (hereinafter, the handle 3802) is an assembly that generallycomprises the instrumentation componentry and therapeutic and/ordiagnostic features of the surgical tool 1600. Thus, as illustrated, thecore 3802 may include a drive end 3804, the elongate shaft 1602 whichextends from the drive end 3804, the end effector 1604, the wrist 1606,the jaws 1610,1612, and the various operational engagement featuresconfigured to affect movement and functionality of the end effector 1604when engaged by the stage assembly 3902. The drive end 3804 includes thevarious drive elements configured to manipulate the variousfunctionality of the end effector 1604, such as opening and closing ofthe jaws 1610,1612, articulation of the wrist 1606, and firing of theend effector 1604. Here, the drive end 3804 includes the driven gear3214 of the first activating mechanism 1638 a (FIG. 32), the pair ofinternally threaded driven gears 3220 a,b of the second activatingmechanism 1638 b, and the driven gear 3218 of the third activatingmechanism 1638 c. As shown in FIG. 39, the stage assembly 3902 includesa carriage or cart 3904, configured to translate between the first andsecond ends 1618 a,b as described herein. Accordingly, the carriage 3904may be referred to as the elevator. The carriage 3904 includes a centralopening or bore 3906. When the removable cap 1906 is removed, the core3802 may be dropped into the stage assembly 3902, with the elongateshaft 1602 being inserted, along the longitudinal axis A₁ (FIG. 16),through the bore 3906 and through an opening at the first end 1618 a ofthe stage assembly 3902 leading into the alignment nozzle 1812 (FIG.16), such that the drive end 3804 is positioned within the bore 3906 andthereby operatively coupling the various drive elements of the drive end3804 with the associated splines 1624 a-c. In this manner, when thedrive end 3804 is engaged within the bore 3906 of the carriage 3904, thedriven gear 3214 of the first activating mechanism 1638 a will becoupled with the first spline 1624 a, the pair of internally threadeddriven gears 3220 a,b of the second activating mechanism 1638 b will becoupled with the second spline 1624 b, and the driven gear 3218 of thethird activating mechanism 1638 c will be coupled with the third spline1624 c. Thus, the core 3802 may be installed on the stage assembly 3902by axially inserting the core 3802 into and through the stage assembly3902.

FIGS. 40 and 41 illustrate another example of the surgical tool 1600incorporating a handle sub-assembly or handle core 4002 configured to bedropped or angled into a stage sub-assembly 4004, according to variousembodiments. FIG. 40 is an isometric view of a portion of the handlecore 4002 (hereinafter, the core 4002) when removed from the stagesub-assembly 4004, according to various embodiments, and FIG. 41 is aside view of the portion of the core 4002 and the stage sub-assembly4004 shown in FIG. 40.

In the illustrated embodiment, the stage sub-assembly 4004 includes acarriage or kart 4006 configured to translate between the first andsecond ends 1618 a,b (FIGS. 36 and 38). Thus, the carriage 4006 mayinclude a carriage nut 4007 that is operatively engaged with the leadscrew 1622 such that rotation of the lead screw 1622 translates thecarriage 4006 along the lead screw 1622. As illustrated, the splines1624 a-c extend through the carriage 4006. Thus, the carriage 4006 mayinclude spline channels extending therethrough for operatively receivingthe splines 1624 a-c such that the splines 1624 a-c may rotate withinthe spline channels of the carriage 4006 as the carriage 4006 translatesalong the lead screw 1622. In the illustrated embodiment, the splines1624 a-c and their corresponding spline channels are arranged within alower one-hundred and eighty degrees of the stage sub-assembly 4004 andthe carriage 4006 to facilitate installation of the core 4002 onto thestage sub-assembly 4004.

Drive gears 4008 a-c may be rotatably mounted to the carriage 4006 andslidingly arranged on each of the splines 1624 a-c such that the drivegears 4008 a-c may slide along the respective spline 1624 a-c whilerotating in unison with the associated spline 1624 a-c. The drive gears4008 a-c may be constrained by the carriage 4006 such that they mayrotate with their respective spline 1624 a-c while translating with thecarriage 4006. Here, the drive gears 4008 a-c are aligned with acorresponding spline channel to slidingly receive their correspondingsplines 1624 a-c. The drive gears 4008 a-c rotate in unison with theirrespective spline 1624 a-c while being axially constrained relative tothe carriage 4006 such that they may slide over the splines 1624 a-c asthe carriage 4006 translates. Thus, the first drive gear 4008 a isconfigured to slide axially along while rotating in unison with thefirst spline 1624 a, the second drive gear 4008 b is configured to slideaxially along while rotating in unison with the second spline 1624 b,and the third drive gear 4008 c is configured to slide axially alongwhile rotating in unison with the third spline 1624 c.

The carriage 4006 may be configured to provide a trough 4010 (or spaceor void) within which the core 4002 may be mounted. In the illustratedexample, the carriage 4006 defines a trough 4010 sized and shaped toreceive the core 4002. Here, the carriage 4006 constrains the core 4002once mounted in the trough 4010, such that the carriage 4006 carries thecore 4002 as it translates. While the carriage 4006 is illustratedhaving a generally U-shaped geometry, it may exhibit differentgeometries, without departing from the present disclosure. For example,the carriage 4006 may include a circular shaped opening for receiving adrive end with drive elements of a drop-in core, such as the core 3802described with reference to FIGS. 38-39.

The drive gears 4008 a-c of the carriage 4006 are each configured todrive, engage, and interact with a corresponding activating mechanism4012 a-c of the core 4002. The activating mechanisms 4012 a-c may bearranged at various locations along the axial length of a drive housingor body 4014 of the core 4002. In the illustrated example, the firstactivating mechanism 4012 a is located at or near a proximal end of thebody 4014, the third activating mechanism 4012 c is located at or near adistal end of the body 4014, and the second activating mechanism 4012 bis located between the first and third activating mechanisms 4012 a,c.As will be appreciated, the activating mechanism 4012 a-c may be locateddifferently, depending on the application.

In some embodiments, one or more of the drive gears 4008 a-c (and/ortheir teeth or cogs) may extend into the trough 4010 to engage(intermesh) the corresponding activating mechanism 4012 a-c of the core4002. In other embodiments, however, one or more of the drive gears 4008a-c may be recessed within the body of the carriage 4006 and thecorresponding activating mechanisms 4012 a-c may extend to engage thedrive gears 4008 a-c. In the illustrated example, the first drive gear4008 a, which is slidingly arranged on the first spline 1624 a, isconfigured to mesh with the first activating mechanism 4012 a such thatrotation of the first spline 1624 a correspondingly actuates the firstactivating mechanism 4012 a and thereby carries out a first function ofthe surgical tool 1600 (e.g., to fire a cutting element). The seconddrive gear 4008 b, which is slidingly arranged on the second spline 1624b, is configured to mesh with the second activating mechanism 4012 bsuch that rotation of the second spline 1624 b correspondingly actuatesthe second activating mechanism 4012 b and thereby carries out a secondfunction of the surgical tool 1600 (e.g., to articulate the wrist 1606of FIG. 35). Lastly, the third drive gear 4008 c, which is slidinglyarranged on the third spline 1624 c, is configured to mesh with thethird activating mechanism 4012 c such that rotation of the third spline1624 c correspondingly actuates the third activating mechanism 4012 cand thereby carries out a third function of the surgical tool 1600(e.g., to open or close the jaws 1610, 1612 of FIG. 35).

Various means may be utilized to retain the body 4014 of the core 4002within the carriage 4006 of the stage sub-assembly 4004. In someexamples, the carriage 4006 includes a pair of sidewalls 4016 a,b oneither side of the trough 4010, and the sidewalls 4016 a,b may be biasedor otherwise angled inward so as to retain the body 4014 when the body4014 is inserted therein. In such embodiments, the core 4002 may bereceived within the trough 4010 via a snap-fit or interference fitengagement. However, other means may be utilized to releasably securethe body 4014 to the carriage 4006, for example, various types ofmechanical fasteners, snaps, magnets, Velcro, etc. In other embodiments,a closure band or shroud portion may rotate about the shroud 1640 (FIG.35) to constrain and enclose the body 4014 on the carriage 4006.

FIGS. 42A-42D depict various alternative embodiments of the shroud 1640that may form part of the surgical tool 1600 of FIG. 16. Morespecifically, FIGS. 42A-42D illustrate example shroud assembliesconfigured to open and close such that a handle core or handlesub-assembly (e.g., the core 3602, 3802, 4002 of FIGS. 36-37, FIGS.38-39, and/or FIGS. 40-41, respectively) may be easily installed on astage sub-assembly (e.g., the stage sub-assembly 3604, 3804, 4004 ofFIGS. 36-37, FIGS. 38-39, and/or FIGS. 40-41, respectively).

FIG. 42A illustrates a shroud assembly 4200 wherein the shroud 1640thereof defines an opening 4202 configured to receive a handlesub-assembly, according to one or more embodiments. In the illustratedexample, the opening 4202 in the shroud 1640 corresponds to the shape ofa handle sub-assembly intended to be inserted (introduced) into theshroud 4204. Thus, the opening 4202 includes an enlarged portion 4204corresponding in size and shape to the body of the handle sub-assembly(e.g., the body 3614, 3814, 4014 of FIGS. 36-37, FIGS. 38-39, and FIGS.40-41, respectively) and a narrow portion 4206 that extends distallyfrom the enlarged portion and is sized and shaped to receive the shaft1602 (FIGS. 36, 38, and 40) and the end effector 1604 (FIGS. 36, 38, and40) of the handle sub-assembly. Accordingly, the handle sub-assembly maybe dropped or angled into the stage sub-assembly through the opening4202.

In some embodiments, a secondary shroud may be provided to selectivelycover the opening 4202, such that the handle sub-assembly may be fullyenclosed and/or sealed from the ambient environment when installed onthe stage sub-assembly. For example, FIGS. 42B-42D illustrate differentembodiments of the shroud assembly 4200 having a secondary shroudconfigured to selectively enclose and seal the opening 4202 in theshroud 1640.

FIG. 42B illustrates another embodiment of the shroud assembly 4200,according to one or more embodiments. In particular, FIG. 42Billustrates an example of the shroud assembly 4200 having a secondaryshroud 4210 configured to slide over the opening 4202 in the shroud1640. In the illustrated embodiment, the shroud 1640 is generallycylindrical in shape and the secondary shroud 4210 is an arcuate memberhaving a curvature substantially similar to the curvature of the shroud1640 and sized to occlude the opening 4202 in the shroud 1640. In someembodiments, the secondary shroud 4210 is provided with a curvature thatis generally concentric with the shroud 1640 when the secondary shroud4212 is slidingly attached (or coupled) to the shroud 1640.

The secondary shroud 4210 may be able to move (slide) relative to theinner or outer circumference of the shroud 1640. In the illustratedembodiment, the secondary shroud 4212 is slidingly disposed over anexterior surface (i.e., the outer circumference) of the shroud 1640 suchthat the secondary shroud 4212 may circumferentially revolve (rotate)over the shroud in a closure direction C; however, in other embodiments,the secondary shroud 4212 may be slidingly disposed within an interior(i.e., the inner circumference) of the shroud 1640 such that thesecondary shroud 4212 circumferentially revolves (rotates) within theshroud 1640. In this manner, the secondary shroud 4210 may overlap aportion of the shroud 1640 by sliding on the perimeter or circumferenceof the shroud 1640 and thereby expose or occlude the opening 4202.

In some embodiments, the secondary shroud 4210 may slide or revolve onthe shroud 1640 between an open position, where the opening 4202 is atleast partially exposed, and a closed position, where the secondaryshroud 4210 occludes the opening 4202. Here, the secondary shroud 4210is shown in an open position such that the opening 4202 is exposed, butthe secondary shroud 4210 may be angularly rotated and slidcircumferentially relative to the shroud 1640 in the closure direction Cto cover the opening 4202. Thus, the secondary shroud 4210 may becircumferentially revolvable (rotatable) relative to the shroud 1640between open and closed positions.

FIG. 42C illustrates another embodiment of the shroud assembly 4200,according to one or more embodiments. In particular, FIG. 42Cillustrates an example of the shroud assembly 4200 having a secondaryshroud 4212 pivotably attached to the shroud 1640. More specifically,the secondary shroud 4212 may be pivotably attached to the shroud 1640at a hinge 4213 that allows the secondary shroud 4212 to pivot or rotaterelative to the shroud 1640 between open and closed positions. The hinge4213 pivotably attaches the secondary shroud 4212 to the shroud 1640 ata distal location of the shroud 1640 such that the secondary shroud 4212may be pivoted upward to an open position, where at least a portion ofthe opening 4202 is sufficiently exposed for dropping or angling thehandle sub-assembly into the opening 4202. Thereafter, the secondaryshroud 4212 may be pivoted downward into a closed position to occludeand possibly seal the opening 4202. In the illustrated embodiment, thesecondary shroud 4212 is shown in an open position, where the opening4202 is exposed for the handle sub-assembly to be angled or droppedthere-into, but the secondary shroud 4212 may be pivoted downward in theclosure direction C to thereby close the shroud assembly 4200 and coverthe opening 4202.

FIG. 42D illustrates another example embodiment of the shroud assembly4200 having a secondary shroud 4214 configured to slide axially over theshroud 1640 to expose or occlude the opening 4202, according to one ormore embodiments. In the illustrated embodiment, the secondary shroud4214 is a tubular-shaped member arranged to slide axially over theshroud 1640. In particular, the secondary shroud 4214 may slideproximally into an open position where the opening 4202 is at leastpartially exposed, or the secondary shroud 4214 may slide distally intoa closed position where the secondary shroud 4214 at least partiallycovers the opening 4202. In the illustrated embodiment, the secondaryshroud 4214 is axially slidable over an external surface of the shroud1640, but in other embodiments, the secondary shroud 4214 may be axiallyslidable (telescope) within an interior of the shroud 1640. Here, thesecondary shroud 4214 is illustrated in an open position, where theopening 4202 is exposed for the handle sub-assembly to be angled ordropped there-into, but the secondary shroud 4214 may be axially slid inthe closure direction C to thereby close the shroud assembly 4200 andcover the opening 4202. Thus, the secondary shroud 4214 may beconfigured to be axially slidable (or telescoping) relative to theshroud 1640 between open and closed positions.

4. Implementing Systems and Terminology.

Implementations disclosed herein provide systems, methods and apparatusfor instruments for use with robotic systems. It should be noted thatthe terms “couple,” “coupling,” “coupled” or other variations of theword couple as used herein may indicate either an indirect connection ora direct connection. For example, if a first component is “coupled” to asecond component, the first component may be either indirectly connectedto the second component via another component or directly connected tothe second component.

The methods disclosed herein comprise one or more steps or actions forachieving the described method. The method steps and/or actions may beinterchanged with one another without departing from the scope of theclaims. In other words, unless a specific order of steps or actions isrequired for proper operation of the method that is being described, theorder and/or use of specific steps and/or actions may be modifiedwithout departing from the scope of the claims.

As used herein, the term “plurality” denotes two or more. For example, aplurality of components indicates two or more components. The term“determining” encompasses a wide variety of actions and, therefore,“determining” can include calculating, computing, processing, deriving,investigating, looking up (e.g., looking up in a table, a database oranother data structure), ascertaining and the like. Also, “determining”can include receiving (e.g., receiving information), accessing (e.g.,accessing data in a memory) and the like. Also, “determining” caninclude resolving, selecting, choosing, establishing and the like.

The phrase “based on” does not mean “based only on,” unless expresslyspecified otherwise. In other words, the phrase “based on” describesboth “based only on” and “based at least on.”

As used herein, the terms “generally” and “substantially” are intendedto encompass structural or numeral modification which do notsignificantly affect the purpose of the element or number modified bysuch term.

To aid the Patent Office and any readers of this application and anyresulting patent in interpreting the claims appended herein, applicantsdo not intend any of the appended claims or claim elements to invoke 35U.S.C. 112(f) unless the words “means for” or “step for” are explicitlyused in the particular claim.

The foregoing previous description of the disclosed implementations isprovided to enable any person skilled in the art to make or use thepresent invention. Various modifications to these implementations willbe readily apparent to those skilled in the art, and the genericprinciples defined herein may be applied to other implementationswithout departing from the scope of the invention. For example, it willbe appreciated that one of ordinary skill in the art will be able toemploy a number corresponding alternative and equivalent structuraldetails, such as equivalent ways of fastening, mounting, coupling, orengaging tool components, equivalent mechanisms for producing particularactuation motions, and equivalent mechanisms for delivering electricalenergy. Thus, the present invention is not intended to be limited to theimplementations shown herein but is to be accorded the widest scopeconsistent with the principles and novel features disclosed herein.

What is claimed is:
 1. A method of assembling a surgical tool,comprising: providing a handle having a first end, a second end, and alead screw and at least one spline extendable between the first andsecond ends; rotating the lead screw in a first direction and therebytranslating an elevator layer of a carriage proximally along alongitudinal axis of the handle, wherein the elevator layer is movablymounted to the lead screw at a carriage nut; removably coupling one ormore additional layers of the carriage to the elevator layer, wherein anelongate shaft extends distally from the one or more additional layersand an end effector is arranged at a distal end of the elongate shaft;penetrating the elevator layer with the end effector and the elongateshaft upon coupling the one or more additional layers to the elevatorlayer; and rotating the lead screw in a second direction opposite thefirst direction and thereby translating the carriage distally along thelongitudinal axis.
 2. The method of claim 1, further comprising couplinga cap to the second end.
 3. The method of claim 2, wherein coupling thecap to the second end further comprises: receiving an end of the atleast one spline in at least one spline coupling provided on the capupon coupling the cap to the second end; and receiving an end of thelead screw in a stage coupling provided on the cap upon coupling the capto the second end.
 4. The method of claim 1, wherein a drive gear and anactivating mechanism are housed in the carriage and operatively coupledtogether such that rotation of the drive gear correspondingly actuatesthe activating mechanism, the method further comprising: inserting theat least one spline through the drive gear and thereby operativelycoupling the drive gear to the at least one spline such that the drivegear is rotatable with rotation of the at least one spline.
 5. Themethod of claim 4, further comprising: rotating the at least one splineby actuating a drive input arranged at the first end and operativelycoupled to the at least one spline to thereby rotate the drive gear; andactuating the activating mechanism as the drive gear rotates.
 6. Themethod of claim 5, further comprising: mating an instrument driver withthe handle at the first end, the instrument driver being arranged at anend of a robotic arm; mating a drive output of the instrument driverwith the drive input as the instrument driver is mated to the handle;and actuating the drive output to rotate the drive input and therebyactuate the activating mechanism.
 7. The method of claim 6, whereinmating the instrument driver with the handle at the first end comprisesinserting the shaft and the end effector through a central aperturedefined longitudinally through the instrument driver.
 8. The method ofclaim 1, further comprising advancing at least a portion of the elevatorlayer past the second end before removably coupling the one or moreadditional layers of the carriage to the elevator layer.
 9. The methodof claim 1, further comprising penetrating the first end with the endeffector and the shaft as the carriage translates distally.
 10. Themethod of claim 1, further comprising removing a cap from the second endto expose a floor of the elevator layer before removably coupling theone or more additional layers of the carriage to the elevator layer. 11.The method of claim 1, wherein one or more snaps extend from the one ormore additional layers for engaging corresponding opening in theelevator layer, the method further comprising inserting the one or moresnaps of the one or more additional layers into the correspondingopenings in the elevator layer and thereby securing the one or moreadditional layers on the elevator floor.
 12. The method of claim 11,further comprising retaining the one or more snaps of the one or moreadditional layers into the corresponding openings in the elevator layeras the carriage distally translates.
 13. The method of claim 12, whereinthe handle includes a shroud within which the carriage translates, themethod further comprising advancing the elevator layer such that theelevator floor and the corresponding openings extend outside of theshroud before removably coupling the one or more additional layers ofthe carriage to the elevator layer.
 14. The method of claim 13, furthercomprising: securing the one or more snaps of the one or more additionallayers within the corresponding openings in the elevator layer as thecarriage pulls the one or more snaps and corresponding openings into theshroud.
 15. The method of claim 1, further comprising detaching the oneor more additional layers from the elevator layer and thereby removingthe one or more additional layers, the elongate shaft, and the endeffector from the handle.
 16. The method of claim 15, furthercomprising: removably coupling one or more additional new layers of thecarriage to the elevator layer, wherein a new elongate shaft extendsdistally from the one or more additional new layers and a new endeffector is arranged at a distal end of the new elongate shaft; andpenetrating the elevator layer with the new end effector and the newelongate shaft upon coupling the one or more additional new layers tothe elevator layer.
 17. A method of assembling a surgical tool,comprising: providing a handle having a first end, a second end, a leadscrew and at least one spline extendable between the first and secondends, and an elevator layer movably mounted to the lead screw at acarriage nut; inserting the at least one spline through a drive gearhoused in at least one additional layer and thereby operatively couplingthe drive gear and the at least one spline such that the drive gear isrotatable with the at least one spline; and removably coupling the atleast one additional layer to the elevator layer to define a carriage,wherein an elongate shaft extends distally from the one or moreadditional layers and an end effector is arranged at a distal end of theelongate shaft, and wherein an activating mechanism is housed in the atleast one additional layer and operatively coupled to the drive gearsuch that rotation of the drive gear correspondingly actuates theactivating mechanism.
 18. The method of claim 17, further comprising:rotating the at least one spline by actuating a drive input arranged atthe first end and operatively coupled to the at least one spline tothereby rotate the drive gear; and actuating the activating mechanism asthe drive gear rotates.
 19. A method of assembling a surgical tool,comprising: removing an end cap from a stage portion of the surgicaltool, the stage portion including: a handle having a first end and asecond end; a lead screw and at least one spline extendable between thefirst and second ends; and an elevator layer of a carriage movablymounted to the lead screw and the at least one spline; and advancing thecarriage to the second end and detaching a first instrument portion fromthe stage portion, the first instrument portion including: one or morefirst additional layers removably coupled to the elevator layer; a firstelongate shaft extending distally from the one or more first additionallayers and having a first end effector arranged at a distal end of thefirst shaft; and replacing the first instrument portion with a secondinstrument portion coupled to the stage portion, the second instrumentportion including: one or more second additional layers removablycoupleable to the elevator layer; a second elongate shaft extendingdistally from the one or more second additional layers and having asecond end effector arranged at a distal end of the second shaft. 20.The method of claim 19, wherein a shroud extends between the first andsecond ends, and advancing the carriage to the second end comprisesadvancing the carriage until the elevator layer at least partiallyprotrudes from the shroud.